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For more recent information or other questions, please contact Cigna Customer Service, at 1-800-668-3813 or, for TTY users, 711, 7 days a week, 8 a.m. – 8 p.m. local time, or visit CignaMedicare.com. The Formulary, pharmacy

Proact select standard formulary

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Tier 2 - Medium copayment covers brand name drugs that are generally When this drug list (formulary) refers to “we,” “us,” or “our,” it means Anthem Blue Cross and Blue Shield. When it refers to “plan” or “our plan,” it means Anthem MediBlue Rx Enhanced (PDP). This document includes a list of the drugs (formulary) for our plan which is current as of 4/1/2021. For an updated formulary, Number: 0223 (Replaces CPBs 283, 324, and 470) Policy.

Your 2021 Premium Standard Formulary Effective January 1, 2021. For the most current list of covered medications or if you have questions: Call the number on your member ID card. Visit your plan’s website on your member ID card to: • Find a participating retail pharmacy by ZIP code.

Voluntary Selection of MCO for New Enrollees . the MCO's Formulary or PDL shall be permitted to continue to receive that prescriptio The ProAct Prescription Drug List references the most commonly prescribed medications available to treat a variety of conditions.

Proact select standard formulary

To achieve this, we include a formulary feature in your prescription drug benefit.
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Proact select standard formulary

2007-01-17 Your 2019 Formulary For the most current list of covered medications or if you have questions: Call the number on your member ID card. Visit your plan’s website on your member ID card to: • Find a participating retail pharmacy by ZIP code. • Look up possible lower-cost medication alternatives. • Compare medication pricing and options. Select Standard.

Effective July 1, 2019.
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Adherence to high ethical standards helps us to hire the best people, to build good relationships with our customers and partners, and is part of our mission to become the world’s most trusted IT service partner. The Board of Directors is fully committed to this Code of Conduct and expects all those who work for Proact to follow it.


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Medications are placed into levels known as “tiers” that will determine what the cost share will be for each product. The drug list is not all-inclusive as there may be prescription drug products that do not appear. The ProAct Prescription Drug List references the most commonly prescribed medications available to treat a variety of conditions. The medications are placed into levels known as “tiers” that will determine what the cost share will be for the member (see below). Tier 1 = generic medications Tier 2 = preferred or formulary brand medications Premium Standard Formulary For the most current listing of covered medications or if you have questions, please visit www.proactrx.com or call the ProAct Help Desk at 1–877–635–9545. y Introduction The ProAct Prescription Drug List references the most commonly prescribed medications available to treat a variety of conditions. The Official Website for St. Lawrence County Government.