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Pharmacy Network, Formulary, and Part D Details

On this page you will find details on the multiple ways you can search our pharmacy network and formulary (drug list). There is also valuable information on Clover Health’s Part D (Prescription) programs and policies, like the Medication Therapy Management Program and Medicare Prescription Payment Plan. 
 

We partner with a network of pharmacies to ensure our plan members can easily access their medications. 

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. These circumstances are described in the Evidence of Coverage (EOC) plan document. You can find the EOC by following this link and entering your zip code to find your plan. 

The formulary is a list of Part D drugs that Clover Health covers for medically necessary purposes, also known as a Drug List. Our comprehensive formulary includes both brand-name and generic drugs that are covered by Clover Health.

Prescription Web Portal by Caremark

This is the most comprehensive way to get pharmacy and formulary information. Sign in to the Clover Member Portal and then click on the Prescription Web Portal by Caremark
 

Key Highlights

  • Check Drug Cost, Formulary Coverage, and Coverage Determination Status
  • Manage Prescriptions and Check Order Status
  • Opt-in for Paperless Part D Explanation of Benefits (EOB)
  • Check In-Network Pharmacies Near You
     
Sign In

Pharmacy Network Directory

Alternatively, you can search for a pharmacy network near you at the link below or manually search through our pharmacy network directory in your state. You can also learn more about mail-order, which can save you money on prescriptions.

Find Pharmacy - 2025

Find Pharmacy - 2026

Interested in using mail-order pharmacy service? Click here to learn more.

View Clover Pharmacy Network Directory

  • Georgia 2025
  • -2026 Coming Soon
  • New Jersey 2025
  • -2026 Coming Soon
  • Pennsylvania 2025
  • -2026 Coming Soon
  • South Carolina 2025
  • -2026 Coming Soon
  • Texas 2025
  • -2026 Coming Soon

Formulary (Drug List)

You can find out if your medication is included in the formulary and see which Tier it is in by clicking on the ‘Search Formulary’ button below for your state. Or you can manually search our entire formulary by state. You can see the copay details for each medication Tier for your plan in your Summary of Benefits. You can find the Summary of Benefits by following this link and entering your zipcode to find your plan.

Searching in New Jersey:

2025 Search Here & 2026 Search Here

Searching in Georgia, Pennsylvania, South Carolina, Texas:

2025 Search Here & 2026 Search Here

View Clover Formulary

  • Georgia 2025
  • -2026 Coming Soon
  • New Jersey 2025
  • -2026 Coming Soon
  • Pennsylvania 2025 
  • -2026 Coming Soon
  • South Carolina 2025
  • -2026 Coming Soon
  • Texas 2025
  • -2026 Coming Soon

If Your Drug Isn't Included or Requires Prior Authorization

Clover Health will cover certain drugs as long as members meet specific prior authorization criteria, step therapy criteria, or other formulary requirements. 

  • Prior Authorization Criteria - 2025 & 2026 Coming Soon
  • Step Therapy Criteria - 2025 & 2026 Coming Soon

If your medication is affected, you have three options: 

Option 1

You can ask your doctor if there's an acceptable alternate medication covered under our formulary.

Option 2

Call our partner in medication services, CVS Caremark, to discuss options:

  • PPO Plans: 1-855-479-3657
  • HMO Plans: 1-844-232-2316

Option 3

Submit an electronic request for Prescription Drug Coverage Determination or download, fill out and fax a form available at Part D Coverage Determinations, Exceptions, Grievances, and Appeals.
 

Changes to Our Formulary

Clover Health 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.
Upcoming Formulary Changes

Medication Therapy Management (MTM) Program

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.

View Program Details