Formulary Details

Clover will cover certain drugs as long as members meet specific prior authorization criteria. Additionally, Clover will only cover some medications after the member has first tried other medications to treat their medical condition.

Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our 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. Here are some possible changes and ways that we’ll keep you informed.

We must alert members taking a certain drug if we make any of these changes:

• remove the drug from our formulary
• Add prior authorization for the drug  
• Add quantity limits and/or step-therapy restrictions on the drug
• Move the drug to a higher cost-sharing tier
• If we're removing a drug from our formulary, we'll either notify affected members 30 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 30-day supply of the 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.

Formulary Details

Clover will cover certain drugs as long as members meet specific prior authorization criteria. Additionally, Clover will only cover some medications after the member has first tried other medications to treat their medical condition.

Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our 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. Here are some possible changes and ways that we’ll keep you informed.

We must alert members taking a certain drug if we make any of these changes:

• remove the drug from our formulary
• Add prior authorization for the drug  
• Add quantity limits and/or step-therapy restrictions on the drug
• Move the drug to a higher cost-sharing tier
• If we're removing a drug from our formulary, we'll either notify affected members 30 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 30-day supply of the 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.

Formulary Details

Clover will cover certain drugs as long as members meet specific prior authorization criteria. Additionally, Clover will only cover some medications after the member has first tried other medications to treat their medical condition.

Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our 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. Here are some possible changes and ways that we’ll keep you informed.

We must alert members taking a certain drug if we make any of these changes:

• remove the drug from our formulary
• Add prior authorization for the drug  
• Add quantity limits and/or step-therapy restrictions on the drug
• Move the drug to a higher cost-sharing tier
• If we're removing a drug from our formulary, we'll either notify affected members 30 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 30-day supply of the 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.

Formulary Details

Clover will cover certain drugs as long as members meet specific prior authorization criteria. Additionally, Clover will only cover some medications after the member has first tried other medications to treat their medical condition.

Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our 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. Here are some possible changes and ways that we’ll keep you informed.

We must alert members taking a certain drug if we make any of these changes:

• remove the drug from our formulary
• Add prior authorization for the drug  
• Add quantity limits and/or step-therapy restrictions on the drug
• Move the drug to a higher cost-sharing tier
• If we're removing a drug from our formulary, we'll either notify affected members 30 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 30-day supply of the 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.

Formulary Details

Clover will cover certain drugs as long as members meet specific prior authorization criteria. Additionally, Clover will only cover some medications after the member has first tried other medications to treat their medical condition.

Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our 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. Here are some possible changes and ways that we’ll keep you informed.

We must alert members taking a certain drug if we make any of these changes:

• remove the drug from our formulary
• Add prior authorization for the drug  
• Add quantity limits and/or step-therapy restrictions on the drug
• Move the drug to a higher cost-sharing tier
• If we're removing a drug from our formulary, we'll either notify affected members 30 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 30-day supply of the 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.