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EssentiaCare Access 2023 Formulary (List of Covered Drugs)

Download the complete Formulary or search the list of covered drugs below.

Tier Deductible 30 day supply - standard cost share 30 day supply - preferred cost share 90 day supply - preferred mail order
Tier 1
Preferred generic drugs
Deductible does not apply to this tier $12 copay $3 copay Available for two preferred copays
Tier 2
Generic drugs
$395 $20 copay $10 copay Available for two preferred copays
Tier 3
Preferred brand drugs
$395 25% coinsurance 17% coinsurance Available for 17% coinsurance
Select insulins Deductible does not apply to select insulin $35 copay $30 copay
Tier 4
Non-preferred drugs
$395 50% coinsurance 50% coinsurance Available for 50% coinsurance
Tier 5
Specialty drugs
$395 25% coinsurance 25% coinsurance Available for 25% coinsurance






Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible. Call Customer Service for more information.


Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.