ESI Formulary 2019

List of certain brand-name medications and compound drugs that may not be covered under the Express Scripts Plan

Publication Date: 12/27/2019
Document Type: Informational Pages
Sponsor: Employee Benefits

Summary
Certain brand-name medications as well as compound drugs that contain certain ingredients may not be covered under the Plan. If you fill a prescription for a non-covered brand-name or compound medication you will be responsible for the full cost of the medication and that cost will not be applied to your out-of-pocket maximum. Talk with your physician about prescribing an alternative covered medication.

Drugs that are excluded under the Plan may be covered if approved in advance through a formulary exception process initiated by your physician and managed by Express Scripts, on the basis that the drug is:

1) medically necessary and essential to your health and safety and/or

2) all covered formulary drugs comparable to the excluded drug have been tried.

Please refer to the document below for drugs covered through your plan.

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