Formulary (Pharmacy and Part D)

The formulary is a list of drugs Clover covers for medically necessary purposes. Clover also partners with in-network pharmacies, which may provide medications at a lower cost.

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Formulary information for 2018 Georgia plans

 

Find out if your drugs are covered

Clover's comprehensive formulary lists all brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.

Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.

 

 

All Georgia plansDownload

Search 2018 formulary


Find a pharmacy

We partner with in-network pharmacies to provide prescription drugs to Plan members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances described in the Evidence of Coverage.

 

All Georgia plans • Download

Search 2018 pharmacies


Learn about 2018 formulary specifics

We require that members meet specific prior authorization criteria for Clover to cover certain drugs. Additionally, Clover will only cover some medications after the member has tried less expensive options. Finally, patients with certain chronic conditions who take eight or more prescription medications are eligible for the Clover Health Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.

Changes to our formulary 

Clover may add or remove drugs from our formulary throughout the year. If we remove a drug from our formulary, add prior authorization for a drug, add quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, we must alert members taking that drug about those changes. If we're removing a drug from our formulary, we'll either notify affected members 60 days prior to making that change, or notify them when they request a refill of that drug (at which time the member will also receive a 60-day supply of that drug). If the Food and Drug Administration deems a drug on our formulary to be unsafe, or the drug's manufacturer removes the drug from the market, we'll immediately remove the drug from our formulary and provide notice to members taking that drug.

Upcoming Changes to Our Formulary >


If your drug isn't included

Call our partners in medication services, CVS Caremark to discuss options.  Or ask your doctor if there's an acceptable alternate medication covered under our formulary.

 

Phone Number
1-855-479-3657



Formulary information for 2018 New Jersey plans

 

Find out if your drugs are covered

Clover's comprehensive formulary lists all brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.

Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.

 

 

All New Jersey plans • Download

Search 2018 formulary


Find a pharmacy

We partner with in-network pharmacies to provide prescription drugs to Plan members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances described in the Evidence of Coverage.

 

All New Jersey plans • Download

Search 2018 pharmacies


Learn about 2018 formulary specifics

We require that members meet specific prior authorization criteria for Clover to cover certain drugs. Additionally, Clover will only cover some medications after the member has tried less expensive options. Finally, patients with certain chronic conditions who take eight or more prescription medications are eligible for the Clover Health Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.

Changes to our formulary 

Clover may add or remove drugs from our formulary throughout the year. If we remove a drug from our formulary, add prior authorization for a drug, add quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, we must alert members taking that drug about those changes. If we're removing a drug from our formulary, we'll either notify affected members 60 days prior to making that change, or notify them when they request a refill of that drug (at which time the member will also receive a 60-day supply of that drug). If the Food and Drug Administration deems a drug on our formulary to be unsafe, or the drug's manufacturer removes the drug from the market, we'll immediately remove the drug from our formulary and provide notice to members taking that drug.

Upcoming Changes to Our Formulary >


If your drug isn't included

Call our partners in medication services, CVS Caremark to discuss options.  Or ask your doctor if there's an acceptable alternate medication covered under our formulary.

 

Phone Number
1-855-479-3657


Formulary information for 2018 Pennsylvania plans

 

Find out if your drugs are covered

Clover's comprehensive formulary lists all brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.

Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.

 

 

All Pennsylvania plans • Download

Search 2018 formulary


Find a pharmacy

We partner with in-network pharmacies to provide prescription drugs to Plan members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances described in the Evidence of Coverage.

 

All Pennsylvania plans • Download

Search 2018 pharmacies


Learn about 2018 formulary specifics

We require that members meet specific prior authorization criteria for Clover to cover certain drugs. Additionally, Clover will only cover some medications after the member has tried less expensive options. Finally, patients with certain chronic conditions who take eight or more prescription medications are eligible for the Clover Health Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.

Changes to our formulary 

Clover may add or remove drugs from our formulary throughout the year. If we remove a drug from our formulary, add prior authorization for a drug, add quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, we must alert members taking that drug about those changes. If we're removing a drug from our formulary, we'll either notify affected members 60 days prior to making that change, or notify them when they request a refill of that drug (at which time the member will also receive a 60-day supply of that drug). If the Food and Drug Administration deems a drug on our formulary to be unsafe, or the drug's manufacturer removes the drug from the market, we'll immediately remove the drug from our formulary and provide notice to members taking that drug.

Upcoming Changes to Our Formulary >


If your drug isn't included

Call our partners in medication services, CVS Caremark to discuss options.  Or ask your doctor if there's an acceptable alternate medication covered under our formulary.

 

Phone Number
1-855-479-3657


Formulary information for 2018 Texas plans

 

Find out if your drugs are covered

Clover's comprehensive formulary lists all brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.

Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.

 

 

All Texas plans • Download

Search 2018 formulary


Find a pharmacy

We partner with in-network pharmacies to provide prescription drugs to Plan members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances described in the Evidence of Coverage.

 

All Texas plans • Download

Search 2018 pharmacies


Learn about 2018 formulary specifics

We require that members meet specific prior authorization criteria for Clover to cover certain drugs. Additionally, Clover will only cover some medications after the member has tried less expensive options. Finally, patients with certain chronic conditions who take eight or more prescription medications are eligible for the Clover Health Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.

Changes to our formulary 

Clover may add or remove drugs from our formulary throughout the year. If we remove a drug from our formulary, add prior authorization for a drug, add quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, we must alert members taking that drug about those changes. If we're removing a drug from our formulary, we'll either notify affected members 60 days prior to making that change, or notify them when they request a refill of that drug (at which time the member will also receive a 60-day supply of that drug). If the Food and Drug Administration deems a drug on our formulary to be unsafe, or the drug's manufacturer removes the drug from the market, we'll immediately remove the drug from our formulary and provide notice to members taking that drug.

Upcoming Changes to Our Formulary >


If your drug isn't included

Call our partners in medication services, CVS Caremark to discuss options.  Or ask your doctor if there's an acceptable alternate medication covered under our formulary.

 

Phone Number
1-855-479-3657


Formulary information for 2019 Arizona plans

 

Find out if your drugs are covered

Clover's comprehensive formulary lists all brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.

Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.

 

 

All Arizona plans • Download

Search 2019 Formulary


Find a pharmacy

We partner with in-network pharmacies to provide prescription drugs to Plan members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances described in the Evidence of Coverage.

 

All Arizona plans • Download

 Search 2019 Pharmacies


Learn about 2019 formulary specifics

We require that members meet specific prior authorization criteria for Clover to cover certain drugs. Additionally, Clover will only cover some medications after the member has tried less expensive options. Finally, patients with certain chronic conditions who take eight or more prescription medications are eligible for the Clover Health Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.


If your drug isn't included

Call our partners in medication services, CVS Caremark to discuss options.  Or ask your doctor if there's an acceptable alternate medication covered under our formulary.

 

Phone Number
1-855-479-3657


Formulary information for 2019 Georgia plans

 

Find out if your drugs are covered

Clover's comprehensive formulary lists all brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.

Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.

 

 

All Georgia plans • Download

Search 2019 Formulary


Find a pharmacy

We partner with in-network pharmacies to provide prescription drugs to Plan members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances described in the Evidence of Coverage.

 

Choice PPO (Standard/Preferred Network) • Download

Search 2019 Pharmacies

 

Choice Plus PPO (National Network) • Download

Search 2019 Pharmacies


Learn about 2019 formulary specifics

We require that members meet specific prior authorization criteria for Clover to cover certain drugs. Additionally, Clover will only cover some medications after the member has tried less expensive options. Finally, patients with certain chronic conditions who take eight or more prescription medications are eligible for the Clover Health Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.


If your drug isn't included

Call our partners in medication services, CVS Caremark to discuss options.  Or ask your doctor if there's an acceptable alternate medication covered under our formulary.

 

Phone Number
1-855-479-3657


Formulary information for 2019 New Jersey plans

 

Find out if your drugs are covered

Clover's comprehensive formulary lists all brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.

Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.

 

 

All New Jersey plans • Download

Search 2019 Formulary


Find a pharmacy

We partner with in-network pharmacies to provide prescription drugs to Plan members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances described in the Evidence of Coverage.

 

All New Jersey plans • Download

Search 2019 Pharmacies


Learn about 2019 formulary specifics

We require that members meet specific prior authorization criteria for Clover to cover certain drugs. Additionally, Clover will only cover some medications after the member has tried less expensive options. Finally, patients with certain chronic conditions who take eight or more prescription medications are eligible for the Clover Health Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.


If your drug isn't included

Call our partners in medication services, CVS Caremark to discuss options.  Or ask your doctor if there's an acceptable alternate medication covered under our formulary.

 

Phone Number for PPO Plans
1-855-479-3657

Phone Number for HMO Plans
1-844-232-2316


Formulary information for 2019 Pennsylvania plans

 

Find out if your drugs are covered

Clover's comprehensive formulary lists all brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.

Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.

 

 

All Pennsylvania plans • Download

Search 2019 Formulary


Find a pharmacy

We partner with in-network pharmacies to provide prescription drugs to Plan members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances described in the Evidence of Coverage.

 

All Pennsylvania plans • Download

Search 2019 Pharmacies


Learn about 2019 formulary specifics

We require that members meet specific prior authorization criteria for Clover to cover certain drugs. Additionally, Clover will only cover some medications after the member has tried less expensive options. Finally, patients with certain chronic conditions who take eight or more prescription medications are eligible for the Clover Health Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.


If your drug isn't included

Call our partners in medication services, CVS Caremark to discuss options.  Or ask your doctor if there's an acceptable alternate medication covered under our formulary.

 

Phone Number
1-855-479-3657


Formulary information for 2019 South Carolina plans

 

Find out if your drugs are covered

Clover's comprehensive formulary lists all brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.

Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.

 

 

All South Carolina plans • Download

Search 2019 Formulary


Find a pharmacy

We partner with in-network pharmacies to provide prescription drugs to Plan members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances described in the Evidence of Coverage.

 

All South Carolina plans • Download

Search 2019 Pharmacies


Learn about 2019 formulary specifics

We require that members meet specific prior authorization criteria for Clover to cover certain drugs. Additionally, Clover will only cover some medications after the member has tried less expensive options. Finally, patients with certain chronic conditions who take eight or more prescription medications are eligible for the Clover Health Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.


If your drug isn't included

Call our partners in medication services, CVS Caremark to discuss options.  Or ask your doctor if there's an acceptable alternate medication covered under our formulary.

 

Phone Number
1-855-479-3657


Formulary information for 2019 Tennessee plans

 

Find out if your drugs are covered

Clover's comprehensive formulary lists all brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.

Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.

 

 

All Tennessee plans • Download

Search 2019 Formulary


Find a pharmacy

We partner with in-network pharmacies to provide prescription drugs to Plan members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances described in the Evidence of Coverage.

 

All Tennessee plans • Download

Search 2019 Pharmacies


Learn about 2019 formulary specifics

We require that members meet specific prior authorization criteria for Clover to cover certain drugs. Additionally, Clover will only cover some medications after the member has tried less expensive options. Finally, patients with certain chronic conditions who take eight or more prescription medications are eligible for the Clover Health Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.


If your drug isn't included

Call our partners in medication services, CVS Caremark to discuss options.  Or ask your doctor if there's an acceptable alternate medication covered under our formulary.

 

Phone Number
1-855-479-3657



Formulary information for 2019 Texas plans

 

Find out if your drugs are covered

Clover's comprehensive formulary lists all brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.

Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.

 

 

All Texas plans • Download

Search 2019 Formulary


Find a pharmacy

We partner with in-network pharmacies to provide prescription drugs to Plan members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances described in the Evidence of Coverage.

 

Classic Plus HMO (National Network) • Download

Search 2019 Pharmacies

 

All other Texas plans (Standard/Preferred Network) • Download

Search 2019 Pharmacies

 


Learn about 2019 formulary specifics

We require that members meet specific prior authorization criteria for Clover to cover certain drugs. Additionally, Clover will only cover some medications after the member has tried less expensive options. Finally, patients with certain chronic conditions who take eight or more prescription medications are eligible for the Clover Health Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.


If your drug isn't included

Call our partners in medication services, CVS Caremark to discuss options.  Or ask your doctor if there's an acceptable alternate medication covered under our formulary.

 

Phone Number for PPO Plans
1-855-479-3657

Phone Number for HMO Plans
1-844-232-2316



Formulary information for 2018 Arizona plans

 

 

This state only has plans available for 2019.

Please select 2019 in the year dropdown.

Formulary information for 2018 South Carolina plans

 

 

This state only has plans available for 2019.

Please select 2019 in the year dropdown.

Formulary information for 2018 Tennessee plans

 

 

This state only has plans available for 2019.

Please select 2019 in the year dropdown.