EssentiaCare Grand 2023 Formulary (List of Covered Drugs)
Download the complete Formulary or search the list of covered drugs below.
Part B Medical Injectable Drug Authorization List (PDF) Updated 11/15/22
|Tier||30 day supply - standard cost share||30 day supply - preferred cost share||90 day supply - preferred mail order|
Preferred generic drugs
|$10 copay||$0 copay||Available for two preferred copays|
|$20 copay||$10 copay||Available for two preferred copays|
Preferred brand drugs
|$47 copay||$47 copay||Available for two preferred copays|
|Select insulins||$35 copay||$30 copay|
|50% coinsurance||50% coinsurance||Available for 50% coinsurance|
|33% coinsurance||33% coinsurance||Available for 33% coinsurance|
Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you. 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.