Definition of Symbols

STATUS SYMBOLS INTERPRETATION Formulary Approved for reimbursement when covered under a member's benefit. If a generic equivalent is available, then the generic is formulary and the brand is non-formulary (unless noted otherwise) and as such, the brand may not be covered or may require a higher copayment/coinsurance depending on the member's benefit. Other restrictions may apply, click on notes or restrictions when applicable. Prior Authorization Required Reimbursement will be allowed only when a request has been submitted by the prescribing physician and approved by the plan. The request must meet current pharmacy policy criteria. Non-Formulary Both the brand and generic product, if available, are not on the formulary and as such, may not be covered or may require a higher copayment/ coinsurance depending on the member's benefit. Not Reimbursed This product is not covered under the prescription drug benefit but may be covered under the member's medical benefit. Generic Available The symbol indicates that a generic equivalent may be available for the brand-name drug. Check formulary status for specific coverage details. Brand and Generic are Formulary The symbol indicates that a generic equivalent is available for the brand-name drug and both the generic product and branded product are on formulary. Notes or Restrictions The notes contain information for criteria and coverage of certain medications.