Express Scripts 2021 National Preferred Formulary Exclusions
HYMOVIS. IMIQUIMOD 3.75% CREAM PUMP. IMITREX^. INDERAL LA^. INDERAL XL, INNOPRAN XL. INDOMETHACIN 20 MG CAPSULES. INGREZZA.
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A. ABILIFY MAINTENA [INJ]. ABSORICA. ACANYA acetaminophen/codeine. ACTEMRA [INJ] acyclovir. ADEMPAS. ADVAIR HFA. AFSTYLA [INJ]. AIMOVIG [ INJ].
Go to express-scripts.com/2021drugs for a full list of formulary
the prescription is filled at an Express Scripts Medicare network pharmacy and other plan rules are followed. For more
Go to express-scripts.com/2020drugs for a full list of formulary exclusions with their covered alternatives or log on to compare drug prices.
Lisa Le Gette, Express-Scripts, Inc. • Kimberly