Empire Plan Advanced Flexible Formulary Documents

Use the formulary lists below to determine which prescription drugs are covered, are excluded, require prior authorization or must be ordered through a specialty pharmacy under your plan. Copayment levels are noted for covered drugs.

Comprehensive Formulary

Comprehensive Formulary (January 2026)
Comprehensive Formulary (October 2025)

Preferred Drug List

Preferred Drug List (January 2026)

Specialty Pharmacy Drug List

Specialty Pharmacy Drug List (January 2026)

Prior Authorization Drug List

Prior Authorization and Specialty Quantity Limit Drug List (January 2026)

Excluded Drug List

Excluded Drug List (January 2026)