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 (October 2025)Comprehensive Formulary (January 2026)
Preferred Drug List
Preferred Drug List (October 2025)Preferred Drug List (January 2026)
Specialty Pharmacy Drug List
Specialty Pharmacy Drug List (October 2025)Specialty Pharmacy Drug List (January 2026)
Prior Authorization Drug List
Prior Authorization and Specialty Quantity Limit Drug List (October 2025)Prior Authorization and Specialty Quantity Limit Drug List (January 2026)
Excluded Drug List
Excluded Drug List (October 2025)Excluded Drug List (January 2026)