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Exhibit 1 FiveTier Formulary Design from www.healthaffairs.org
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Exhibit 1 FiveTier Formulary Design (Medicare-Medicaid Plan) H9576_PhmDrugList25 Approved 7/18/2024 Last Updated: 1/21/2025 Formulary ID: 00025293 Version: 9 2025 Formulary: List of covered drugs For more recent information or other questions, contact us at 1-844-812-6896 and TTY 711, 8 am to 8 pm, For more recent information or other questions, contact us at 1 (888) 347-3630.
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