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Pharmacy Resources for Providers | Ambetter from Coordinated Care
Pharmacy
We are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Ambetter Health members. View the current Preferred Drug List (PDL) to find more information on the drugs that Ambetter Health covers.
- 2025 Formulary/Prescription Drug List - Cascade (PDF)
- 2025 Formulary/Prescription Drug List (PDF)
- 2025 Formulary Changes (PDF)
- 2024 Formulary/Prescription Drug List - Cascade (PDF)
- 2024 Formulary/Prescription Drug List (PDF)
- 90-Day Extended Supply Medications (PDF)
- Non-Formulary and Step Therapy Exception Request Form (PDF)
Prescription Drug Exception Process
A Member, a Member’s Authorized Representative or a Member’s prescribing Physician may request an exception to our Prescription Drug requirements, including but not limited to:
- A substitution of a Preferred Drug, therapy or medication including specialty and no Specialty Drugs except vaccines;
- Drug benefit limitations and procedures under our drug utilization management program such as step therapy; dosage limitations or therapeutic substitutions;
- Access to drugs, therapies or medication that are on and off of our Prescription Drug Formulary;
- Continuation the use of a drug if the tiering structure changes during the year, and the Member is using the drug at the time of the change.
To request an exception, complete the Non-Formulary and Step Therapy Exception Request Form (PDF).
To check whether medication has any coverage restriction, refer to the Clinical Policies.
Requests for non-formulary drugs, under the pharmacy benefit, will be reviewed againstmedication-specific prior authorization criteria when available. If there are no medication-specificcriteria, request will be subject to the policy HIM.PA.103 – Brand Name Override and Non-Formulary Medications (PDF).
Non urgent exception request
A member, a member’s designee or a member’s prescribing Physician may request a standard Prescription Drug exception review. The request can be made in writing or via telephone. If we do not receive enough information to make a decision, we will notify the prescribing Physician and indicate the specific information we need.
Urgent (Expedited) exception request
A member, a member’s designee or a member’s prescribing Physician may request an expedited review based on exigent circumstances. Exigent circumstances exist when a member is suffering from a health condition that may seriously jeopardize the member’s life, health, or ability to regain maximum function or when a member is undergoing a current course of treatment using a nonformulary drug. If we do not receive enough information to make a decision, we will notify the prescribing Physician and indicate the specific information we need to make a decision.
The request can be made in writing or via telephone.