• Ambetter Formulary 2022 Texas2023 Formulary/Prescription Drug List - Cascade (PDF) 2023 Formulary/Prescription Drug List (PDF) 2022 Preferred Drug List Cascade (PDF) 2022 Preferred Drug List (PDF) 90-Day Extended Supply Medications (PDF) PA Forms. We are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Ambetter members. We look forward to serving you! Curious on next steps? To view next steps and plan details:. Superior HealthPlan follows the Texas. With a wide variety of plans to fit your needs and budget, Ambetter Health continues to provide stability and health care options ensuring you receive expert care whenever and wherever you need it. Some medications require prior authorization (PA) or have limitations on age, dosage, and maximum quantities. Learn more about the Ambetter pharmacy resources and Missouri PDL. Ambetter">Affordable Health Insurance Plans. Refer to instructions for the following searches: Formulary Drug Search. The Texas Health and Human Services (HHS) will publish the semi-annual update of the Texas Medicaid Preferred Drug List (PDL) on Thursday January 27 th, 2022. Ambetter will mail tax Form 1095-B to everyone who had individual or group health coverage with us in 2022. 2023 Formulary/Prescription Drug List (PDF) 2022 Preferred Drug List (PDF) PA Forms CoverMyMeds. Ambetter submits the information on Form 1095-B to the IRS and your State Franchise Tax Board to document your health coverage in 2022. The list includes: Medicare Part D drugs Some Medicaid covered prescription and over-the-counter drugs and items In general, we cover drugs if they are medically necessary. The pharmacy program does not cover all medications. Each metal level provides a balance on monthly premium payment and out-of-pocket expenses, as well as access to Ambetter's in-network providers. 2022 Preferred Drug List; 2021 Preferred Drug List;. 2023 Formulary Changes (PDF) 2022 Preferred Drug List (PDF) Extended Day Supply. When the search box appears, type the name of your drug. Don't see your state listed? Contact us. Affordable Health Insurance in Indiana. Ambetter Covered Drug Changes Effective January 1, 2022. Ambetter covers prescription medications and certain over-the-counter medications when ordered by an Ambetter provider. Affordable Health Insurance in Texas | Ambetter from Superior HealthPlan Get the health coverage you deserve. PDF 2022 Prescription Drug List. Ifwedenyyourrequestfor Prior Authorization. Ambetter Illinois Formulary Updated December 1, 2022 2. If you are affected by formulary changes listed below, please speak with your provider to find an appropriate alternative or request coverage exception. Formulary; Formulary Search; Clinician-Administered Drugs; Clinical Prior Authorization - Traditional Medicaid; MCO Clinical Prior Authorizations; Preferred Drugs;. Effective January 27, 2022: Texas Medicaid Preferred Drug. Delivery is free and can be to your home, workplace, or any address you choose. 2023 Formulary Changes (PDF) 2022 Preferred Drug List (PDF) Extended Day Supply Pharmacies are now listed in our Find a Provider tool 90-Day Extended Supply Medications (PDF) Forms Download Prescription Claim Reimbursement Form - English (PDF) Download Prescription Claim Reimbursement Form - Spanish (PDF). The drug list is updated monthly. Our contact information is on the cover. Ambetter Participating Pharmacies. BRONZE Ambetter Bronze Care Bronze Care plans cover your essential healthcare needs. Use our Preferred Drug List to find more information on the drugs that Ambetter covers. To obtain prior authorization for a non-formulary drug, your provider must fill out the Prior Authorization form. The Texas Health and Human Services (HHS) will publish the semi-annual update of the Texas Medicaid Preferred Drug List (PDL) on Thursday January 27 th, 2022. © 2022 Coordinated Care Corporation. With a wide variety of plans to fit your needs and budget, Ambetter Health continues to provide stability and health care options ensuring you receive expert care whenever and wherever you need it. Envolve Pharmacy Solutions will respond via fax or phone within 24 hours of receipt of all necessary information for urgent requests, and within 72 hours for non-urgent requests, unless state law requires faster response. We are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Ambetter members. Activate your Coverage Pay your premium. Affordable Health Insurance in Texas | Ambetter from Superior HealthPlan. Ambetter from Superior HealthPlan works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. Pharmacies should contact the contracted PBM and the Vendor Drug Program directly for contracting assistance. You also have the option to print the PDF drug list. Ambetter Health Welcomes 2023 Plan Year">Ambetter Health Welcomes 2023 Plan Year. CVS Mail Order As an Ambetter member, you can maximize your pharmacy benefits by filling your prescriptions with CVS Caremark Mail Service Pharmacy, the only in-network mail order pharmacy. 2023 Formulary Changes 2023 Formulary Changes Following formulary changes will take place on 1/1/2023. The update will be based on changes presented at the Vendor Drug Program (VDP) Drug Utilization Review (DUR) Board meetings in January and April 2022. Anti-TNF-alpha - Monoclonal Antibodies. As a combined PBM and specialty drug management solution that is integrated across the medical and pharmacy benefit, we customize and constantly innovate for our plan sponsor partners and deliver personal, caring service for their members. com 2022 Prescription Drug List Effective January 1, 2022 )RUPXODU \ ,QWURGXFWLRQ)2508/$5< Ambetter Formulary Updated December 1, 2022. The Texas Health and Human Services (HHS) will publish the semi-annual update of the Texas Medicaid Preferred Drug List (PDF) on Thursday July 28 th, 2022. ” Check your email for the verification code and enter it to validate your account. Texas Prescription Drug Coverage. Date: 01/13/22. View the current Preferred Drug List (PDL) to find more information on the drugs that Ambetter covers. Use our Preferred Drug List to find more information on the drugs that Ambetter covers. List of Drugs (Formulary) List of Drugs (Formulary) Our List of Drugs (Formulary) shows the drugs we cover. Thank you for choosing Ambetter Health. To obtain prior authorization for a non-formulary drug, your provider must fill out the Prior Authorization form. PDL by Drug Class Effective 04/01/2023. Find a Doctor Need health insurance? See if You Qualify. Updated December 1, 2022: List of Drugs - Search Tool List of Drugs - English (PDF). Your plan will generally cover the drugs listed in our drug list as long as: l The drug is used for a medically accepted indication. The Texas Health and Human Services (HHS) will publish the semi-annual update of the Texas Medicaid Preferred Drug List (PDF) on Thursday July 28 th, 2022. Join Ambetter show Join Ambetter menu. Effective January 27, 2022: Texas Medicaid Preferred Drug List Updates. Arkansas Pharmacy Coverage. To make sure that our members have access to appropriate drugs, we review and update our formulary on a monthlybasis ; B) RIGHT TO APPEAL a. Ambetter from Magnolia Health">Pharmacy Resources for Providers. Step Therapy In some cases, you must first try certain drugs before Ambetter covers another drug for your medical condition. 2023 Formulary/Prescription Drug List (PDF) 2022 Preferred Drug List (PDF) 90-Day Extended Supply Medications (PDF). Each metal level provides a balance on monthly premium payment and out-of-pocket expenses, as well as access to Ambetter's in-network providers. Ambetter’s formulary is considered a closed formulary. 90-Day Extended Supply Medications (PDF). 5x* their regular copay for a three-month fill. Affordable Health Insurance in Indiana | Ambetter from MHS Indiana. View the current Preferred Drug List (PDL) to find more information on the drugs that Ambetter covers. Make your first payment to access great benefits. Formulary Product Search. 2022: Texas Medicaid Preferred Drug List ">Effective July 28, 2022: Texas Medicaid Preferred Drug List. Ambetter Pharmacy Coverage. To access the Texas Medicaid/CHIP Vendor Drug Program (VDP), including the Medicaid formulary and Preferred Drug List (PDL), visit the Texas Vendor Drug website. 2023 Formulary Changes (PDF) 2022 Preferred Drug List (PDF) Extended Day Supply Pharmacies are now listed in our Find a Provider tool 90-Day Extended Supply Medications (PDF) Forms Download Prescription Claim Reimbursement Form - English (PDF) Download Prescription Claim Reimbursement Form - Spanish (PDF) Complaint Appeal Request Form (PDF). 2022 Prescription Drug List. Each metal level provides a balance on monthly premium payment and out-of-pocket expenses, as well as access to Ambetter's in-network providers. Ambetter works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. Ambetter Covered Drug Changes Effective January 1, 2022">Ambetter Covered Drug Changes Effective January 1, 2022. Alabama Arizona Arkansas California Florida Georgia Illinois Indiana Kansas Kentucky Louisiana Michigan Mississippi Missouri Nebraska Nevada New Hampshire New Jersey New Mexico. For questions regarding pharmacy services contact us at 877-725-7749. 2023 Formulary/Prescription Drug List (PDF). Ambetter works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. PDF 2022Prescription Drug List. We are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Ambetter members. Find Ambetter coverage in your state. Texas Pharmacy Resources for Providers. To find the cost of your medications please use our Drug Cost Tool. Ambetter from Home State Health members can access appropriate and cost-effective drug therapy through our pharmacies. Ambetter covers prescription. Affordable Health Insurance in Mississippi | Ambetter from Magnolia Health. Ambetter covers prescription medications and certain over-the-counter medications when ordered by an Ambetter provider. PDL by Drug Name Effective 04/01/2023. Affordable Health Insurance in Texas | Ambetter from Superior HealthPlan. We are legally required to do this for all individuals to whom we provided. Your plan and a team of health care providers work together in selecting drugs that are needed for well-rounded care and treatment. Use our Preferred Drug List to find more information on the drugs that Ambetter covers. All 2022 Individual Plans use the Health Insurance Marketplace 6 Tier Drug List. The Texas Health and Human Services (HHS) will publish the semi-annual update of the. This means that any drug not found in the formulary requires prior authorization. These plans are offered off the Texas Health Insurance Marketplace. For prior authorization of medications covered by the VDP, contact the contracted PBM at 1-866-399-0928. This completelist of prescription drugs covered by your plan is current as of November 1, 2022. methylphenidate hcl tabs 10 MG, 20 MG. One way that we do that is by monitoring the cost-effectiveness of drugs that are covered by our plan. Missouri Pharmacy Coverage. Join Ambetter show Join Ambetter menu. Fill in your personal information, click “validate,” then complete the credentials form and click “create an account. Envolve Pharmacy Solutions will respond via fax or phone within 24 hours of receipt of all necessary information for urgent requests, and within 72 hours for non-urgent requests, unless state law requires faster response. 2023 Formulary/Prescription Drug List (PDF) 2022 Preferred Drug List (PDF. More on Ambetter's pharmacy program. What is Ambetter? Shop and Compare Plans; Find a Doctor; Shop and Compare Plans. What is Ambetter? Shop and Compare Plans; Find a Doctor; Shop and Compare Plans. Ambetter Health Welcomes 2023 Plan Year NEWS News Ambetter from Superior HealthPlan Welcomes New and Current Members for the 2023 Plan Year Date: 10/24/22 As the health insurance landscape continues to evolve, some insurance carriers have elected to exit some markets. Use our Preferred Drug List to find more information on the. This includes: Individual & Family Plans, off-exchange. List of Drugs (Formulary). AmBetter offers lower premiums in bronze, silver and gold coverage categories with a full-price (unsubsidized) premium compared to BCBS of Texas. Because protecting peoples’ health is why we’re here, and it’s what we’ll always do. Effective January 27, 2022: Texas Medicaid Preferred Drug List …. Catastrophic plans, on-exchange. 2023 Preferred Drug List. Ambetter covers prescription medications and certain over-the-counter (OTC) medications when ordered by a practitioner. Ambetter has you covered, with plans available in 27 states nationwide. Refer to instructions for the following searches: Formulary Drug Search. Envolve Pharmacy Solutions will respond via fax or phone within 24. Login and use their pharmacy search to find one near you! Major Pharmacies in Your State. Formulary Commercial Plans Ambetter from Coordinated Care - Washington Clinical and Payment Policies Medicaid Absolute Total Care Absolute Total Care - Preferred Drug List (PDF) Absolute Total Care - Preferred Drug List (JSON) Arizona Complete Health Arizona Complete Health - Integrated Preferred Drug List - English (PDF). Envolve Pharmacy Solutions will respond via fax or phone within 24. Updated December 1, 2022: List of Drugs - Search Tool List of Drugs - English (PDF). 2023 Formulary Changes (PDF) 2022 Preferred Drug List (PDF) Extended Day Supply Pharmacies are now listed in our Find a Provider tool 90-Day Extended Supply. To obtain prior authorization for a non-formulary drug, your provider must fill out the Prior Authorization form. To search for your drug in the PDF, hold down the “Control” (Ctrl) and “F” keys. 2023 Formulary/Prescription Drug List - Cascade (PDF) 2023 Formulary/Prescription Drug List (PDF) 2022 Preferred Drug List Cascade (PDF) 2022 Preferred Drug List (PDF) 90-Day Extended Supply Medications (PDF) PA Forms CoverMyMeds. 2023 Formulary/Prescription Drug List (PDF) 2022 Preferred Drug List (PDF. If you are enrolled in an individual on-exchange plan (with the exception of catastrophic plans), or a Medicare plan you will not receive a 1095-B form. Formulary Formulary Search Formulary Search March 23: Pharmacy Resolution Help Desk Down Due To Statewide Outages Drug Search Drug NDC Name Search by brand/generic name Drug Manufacturer PDL Class Clinical Prior Authorizations and Policy Clinical PA Required PDL PA Required Medicaid CHIP CSHCN HTW HTWPlus KHC 90% utilization Family Planning. Ambetter's Pharmacy Program. Ambetter from MHS Indiana is dedicated to providing appropriate and cost-effective drug therapy and Ambetter pharmacy resources for our members. 2021 Prescription Drug List. Ambetter Covered Drug Changes Effective January 1, 2022 Ambetter from Sunshine Health wants to make sure that our members receive the best care at the lowest. You can count on us to share helpful information about COVID, how to prevent it, and recognize its symptoms. Ambetter Illinois Formulary Updated December 1, 2022 3. We are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Ambetter members. Ambetter covers prescription medications and certain over-the-counter (OTC) medications when ordered by a practitioner. For a formulary exception request Ambetter from Superior HealthPlan requires: Documentation of failure of at least two PDL agents within the same therapeutic class (provided two agents exist in the therapeutic category with comparable labeled indications) for the same diagnosis (e. Ambetter Formulary Updated December 1, 2022. Relay Texas/TTY users should call 1-800-735-2989. 2022 Preferred Drug List (PDF). Ambetter Covered Drug Changes Effective January 1, 2022 Ambetter from Sunshine Health wants to make sure that our members receive the best care at the lowest premium. Select your state below to see plans in your area. Page 1 of 7 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2022 – 12/31/2022 Ambetter Value Silver 30: Coverage for: Individual/Family | Plan Type: HMO. com 2022 Prescription Drug List Effective January 1, 2022 )RUPXODU \ ,QWURGXFWLRQ)2508/$5< Ambetter Formulary Updated December 1, 2022. As a combined PBM and specialty drug management solution that is integrated across the medical and pharmacy benefit, we customize and constantly innovate for our plan sponsor partners and deliver personal, caring service for their members. What is Ambetter? Shop and Compare Plans; Find a Doctor; Shop and Compare Plans. BRONZE Ambetter Bronze Care Bronze Care plans cover your essential healthcare needs. Drug List by Health Benefit Plan: 2022 Blue Cross and Blue Shield of Texas employer-offered small group plans use the Health Insurance Marketplace 6 Tier Drug List. Pharmacy. Your doctor must ask for approval from Ambetter before some drugs will be covered. 2023 Formulary/Prescription Drug List (PDF) 2022 Preferred Drug List (PDF). Ambetter Formulary Updated December 1, 2022 2. QL(4 ea daily) dextroamphetamine sulfate cp24 5 MG. PDF 2023 Formulary Changes. Please enter your zip code to see plans available in your area. Ambetter's formulary is considered a closed formulary. To obtain prior authorization for a non-formulary drug, your provider must fill out the Prior Authorization form. Drug Name Drug Tier Requirement s/Limits. Ambetter Health Welcomes 2023 Plan Year NEWS News Ambetter from Superior HealthPlan Welcomes New and Current Members for the 2023 Plan Year Date: 10/24/22 As the health insurance landscape continues to evolve, some insurance carriers have elected to exit some markets. Thank you for choosing Ambetter Health. 2023 Formulary/Prescription Drug List - Cascade (PDF) 2023 Formulary/Prescription Drug List (PDF) 2022 Preferred Drug. We are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Ambetter members. Ambetter from Sunflower Health Plan">Kansas Pharmacy Coverage. 2023 Formulary Changes (PDF) 2022 Preferred Drug List (PDF) Extended Day Supply Pharmacies are now listed in our Find a Provider tool 90-Day Extended Supply Medications (PDF) Forms Download Prescription Claim Reimbursement Form - English (PDF) Download Prescription Claim Reimbursement Form - Spanish (PDF) Complaint Appeal Request Form (PDF). 2022 Preferred Drug List (PDF). 2023 Formulary Changes (PDF) 2022 Preferred Drug List (PDF) Extended Day Supply Pharmacies are now listed in our Find a Provider tool 90-Day Extended Supply Medications (PDF) Forms Download Prescription Claim Reimbursement Form - English (PDF) Download Prescription Claim Reimbursement Form - Spanish (PDF) Complaint Appeal Request Form (PDF). Ambetter works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. To make sure that our members have access to appropriate drugs, we review and update our formulary on a monthlybasis ; B) RIGHT TO APPEAL a. Affordable Health Insurance in Mississippi. Formulary Formulary Search Formulary Search March 23: Pharmacy Resolution Help Desk Down Due To Statewide Outages Drug Search Drug NDC Name Search by brand/generic name Drug Manufacturer PDL Class Clinical Prior Authorizations and Policy Clinical PA Required PDL PA Required Medicaid CHIP CSHCN HTW HTWPlus KHC 90% utilization Family Planning. Affordable Health Insurance in Texas. Ambetter offers Bronze, Silver and Gold Care plans. For example, if Drug A and Drug B both treat your medical condition, Ambetter may not cover Drug B unless you try Drug A first. We are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Ambetter members. Ambetter Formulary Updated December 1, 2022. View our 2022 Ambetter Plan Brochure (PDF) to see the valuable benefits each plan has to offer. But the real savings is with the Silver plans, with AmBetter’s cheapest plan carrying a monthly premium 30% lower than a comparable BlueCross BlueShield Texas plan. 2023 Formulary Changes (PDF) 2022 Preferred Drug List (PDF) Extended Day Supply Pharmacies are now listed in our Find a Provider tool ; 90-Day. Use our Preferred Drug List to find more information on the. Florida Prescription Drug Coverage. Formulary Commercial Plans Ambetter from Coordinated Care - Washington Clinical and Payment Policies Medicaid Absolute Total Care Absolute Total Care - Preferred Drug List (PDF) Absolute Total Care - Preferred Drug List (JSON) Arizona Complete Health Arizona Complete Health - Integrated Preferred Drug List - English (PDF). Formulary Product Search. I superior FROM healthplan. To get updated information about the covered drugs or if you have questions, please call Customer Service. 2023 Formulary/Prescription Drug List (PDF) 2022 Preferred Drug List (PDF. 2022: Texas Medicaid Preferred Drug ">Effective January 27, 2022: Texas Medicaid Preferred Drug. See coverage in your area; Find doctors. Pharmacies should contact the contracted PBM and the Vendor Drug Program directly for contracting assistance. Ambetter Formulary Updated December 1, 2022 2. migraine, neuropathic pain, etc. See coverage in your area; Find doctors and hospitals; View pharmacy program benefits; View essential health benefits; Find and enroll in a plan that's right for you. Health Savings Accounts (HSAs) are available with certain Bronze plans. Ambetter’s Pharmacy Program. With a wide variety of plans to fit your needs and budget, Ambetter Health continues to provide stability and health care options ensuring you receive expert care whenever and wherever you need it. Affordable Health Insurance in Texas | Ambetter from Superior. Pharmacy providers can download or view/search a Maximum Allowable Cost (MAC) list by visiting the CVS Pharmacy Portal. Use your ZIP Code to find your personal plan. The list includes: Medicare Part D drugs Some. 2022Prescription Drug List. Page 1 of 7 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2022 – 12/31/2022 Ambetter Value Silver 30: Coverage for: Individual/Family | Plan Type: HMO. For information regarding contracting as a network pharmacy, please visit the Pharmacy Services website. List of Drugs (Formulary) List of Drugs (Formulary) Our List of Drugs (Formulary) shows the drugs we cover. 1B EVEKEO TABS (Use amphetamine sulfate) 3. Ambetter has you covered, with plans available in 27 states nationwide. © 2022 Coordinated Care Corporation. Formulary Commercial Plans Ambetter from Coordinated Care - Washington Clinical and Payment Policies Medicaid Absolute Total Care Absolute Total Care - Preferred Drug List (PDF) Absolute Total Care - Preferred Drug List (JSON) Arizona Complete Health Arizona Complete Health - Integrated Preferred Drug List - English (PDF). Ambetter Health Welcomes 2023 Plan Year NEWS News Ambetter from Superior HealthPlan Welcomes New and Current Members for the 2023 Plan Year Date: 10/24/22 As the health insurance landscape continues to evolve, some insurance carriers have elected to exit some markets. Use our Preferred Drug List to find more information on the drugs that Ambetter covers. Ambetter offers Bronze, Silver and Gold Care plans. *Statistical claims and the #1 Marketplace. com Ambetter from Coordinated Care is underwritten by Coordinated Care Corporation. 2023 Formulary Changes (PDF) 2022 Preferred Drug List (PDF) 2022 Preferred Drug List - Balanced Care 7 (PDF) Extended Day Supply Pharmacies are now listed in our Find a Provider tool 90-Day Extended Supply Medications (PDF) Forms Prescription Claim Reimbursement Form - English (PDF) Prescription Claim Reimbursement Form -. The update will be based on changes presented at the Vendor Drug Program (VDP) Drug Utilization Review (DUR) Board meetings in July and November 2021. Each metal level provides a balance on monthly premium payment and out-of-pocket expenses, as well as access to. This drug list has changed since last year. This means that any drug not found in the formulary requires prior authorization. The Ambetter pharmacy program does not cover all medications. Pay Now Find doctors, specialists and hospitals near you. dextroamphetamine sulfate cp24 10 MG, 15 MG. Affordable Health Insurance in Texas | Ambetter from Superior. Ambetter Health Welcomes 2023 Plan Year. Effective July 28, 2022: Texas Medicaid Preferred Drug List. To access the Texas Medicaid/CHIP Vendor Drug Program (VDP), including the Medicaid formulary and Preferred Drug List (PDL), visit the Texas Vendor Drug website. Get medical help from doctors via video and phone. Children's Medical Services (CMS) Ambetter Provider Educational Resources Envolve Pharmacy Solutions provides quarterly educational outreach material to providers on common drug therapy and disease problems with the aim of improving prescribing and dispensing practices. com Ambetter from Coordinated Care is underwritten by Coordinated Care Corporation. Product Name Generic Name Change AUBAGIO Teriflunomide Tab 14 Mg Quantity limit of 1 unit per day added AUGMENTED BETAMETHASONE DIPROPIONATE Betamethasone Dipropionate. Use our Preferred Drug List (Formulary) to find more information on the drugs that Ambetter covers. To obtain prior authorization for a non-formulary drug, your provider must fill out the Prior Authorization form. Affordable Health Insurance Plans. Health Insurance Marketplace 6 Tier Drug List. 2023 Formulary/Prescription Drug List (PDF) 2022 Preferred Drug List (PDF) 90-Day Extended Supply Medications (PDF) PA Forms CoverMyMeds. Enter the date in MM/DD/YYYY format, including leading 0 if needed (e. Formulary Commercial Plans Ambetter from Coordinated Care - Washington Clinical and Payment Policies Medicaid Absolute Total Care Absolute Total Care - Preferred Drug. View the current Preferred Drug List (PDL) to find more information on the drugs that Ambetter covers. PDF Affordable Health Insurance in Texas. 2023 Formulary/Prescription Drug List (PDF). 2023 Formulary Effective January 1, 2023. Registration should be complete. Learn more about HSA plans on The Fidelity HSA® website. Where are you located? We ask this to show you the best options available in your state. Ambetter of North Carolina">Pharmacy Resources for Providers. Ambetter covers prescription medications and certain over-the-counter (OTC) medications when ordered by a practitioner. A drug list, or formulary, is a list of prescription drugs covered by your plan. 2023 Formulary/Prescription Drug List - Cascade (PDF) 2023 Formulary/Prescription Drug List (PDF) 2022 Preferred Drug. Ambetter offers Bronze, Silver and Gold Care plans.