NetResults Formulary

A formulary, or a drug list, is a guide to the products covered by your plan’s prescription drug benefit. It contains covered products for a broad range of conditions and is updated often. This list should be used along with other plan documents to help you understand your coverage.

Decisions about the need for a prescription product must be made solely by you and your physician in accordance with the patient/physician relationship. If your provider determines that you need a product that is not covered by the formulary or has prerequisites for coverage, you or your prescriber may initiate the coverage review process online (primetherapeutics.com) or by calling the Customer Service number (on the back of your card) any time, 24 hours a day, 7 days a week.

You can view the formulary by downloading the printable version below or by using the search tool on this page.

How to Search For Drugs

Use the alphabetical list to search by the first letter of your medication.

Search by typing part of the generic (chemical) and brand (trade) names.

Search by selecting the therapeutic class of the medication you are looking for.

Printable Files

The following files require Adobe Acrobat. Download Adobe Acrobat

Printable Formulary

2025 Printable Formulary

Printable Drug List Effective 1/1/2025

Plan Tiering Explanation

Please Note: This section may not apply to your plan. Your plan setup may also include a copay for specialty medications. Please refer to your plan document for coverage details.

3 Tier Plans
Tier 1: preferred generics (p) & non-preferred generics (np)
Tier 2: Preferred Brands (P)
Tier 3: Non-Preferred Brands (NP)

4 Tier Plans
Tier 1: preferred generics (p)
Tier 2: non-preferred generics (np)
Tier 3: Preferred Brands (P)
Tier 4: Non-Preferred Brands (NP)

Nondiscrimination and Languages Notice

Nondiscrimination + Languages Notice