- prescription drugs
- Changes to Our Drug List
Changes to Our Drug List
It’s not very common, but during the year, we may decide to:
- Remove a drug from our list
- Add prior authorization, step therapy requirements, and quantity limits to a drug
- Move a drug to a higher cost tier
If any of these things happen with a drug you’re taking, we’ll let you know at least 30 days before the change goes into place.
Select your plan name below to view recent changes. We update these documents on the first of each month.
Alabama
- Devoted CHOICE Alabama (PPO)
- Devoted CHOICE GIVEBACK Alabama (PPO)
- Devoted CORE Alabama (HMO)
- Devoted DUAL Alabama (HMO D-SNP)
- Devoted DUAL PLUS Alabama (HMO D-SNP)
- Devoted GIVEBACK Alabama (HMO)
Arizona
- Devoted BE WELL Arizona (HMO C-SNP)
- Devoted BE WELL PLUS Arizona (HMO C-SNP)
- Devoted CHOICE Arizona (PPO) - Cochise, Coconino, Graham, La Paz, Pima, Santa Cruz, Yavapai, and Yuma counties
- Devoted CHOICE Arizona (PPO) - Maricopa and Pinal counties
- Devoted CHOICE GIVEBACK Arizona (PPO)
- Devoted CORE Arizona (HMO) - Coconino, Pima, and Yavapai counties
- Devoted CORE Arizona (HMO) - Maricopa and Pinal counties
- Devoted EXTRA Arizona (HMO)
- Devoted GIVEBACK Arizona (HMO)
- Devoted PRIME Arizona (HMO)
- Devoted SELECT Arizona (HMO)
Arkansas
- Devoted CHOICE Arkansas (PPO)
- Devoted CHOICE DUAL Arkansas (PPO D-SNP)
- Devoted CHOICE DUAL PLUS Arkansas (PPO D-SNP)
- Devoted CHOICE GIVEBACK Arkansas (PPO)
Colorado
- Devoted CHOICE Colorado (PPO)
- Devoted CHOICE GIVEBACK Colorado (PPO)
- Devoted CORE Colorado (HMO)
- Devoted DUAL Colorado (HMO D-SNP)
- Devoted DUAL PLUS Colorado (HMO D-SNP)
- Devoted GIVEBACK Colorado (HMO)
Florida
- Devoted CHOICE Florida (PPO)
- Devoted CHOICE GIVEBACK Florida (PPO) - all counties except Pensacola
- Devoted CHOICE GIVEBACK Florida (PPO) - Pensacola county
- Devoted CORE Florida (HMO)
- Devoted DUAL Florida (HMO D-SNP)
- Devoted DUAL PLUS Florida (HMO D-SNP)
- Devoted EXTRA Florida (HMO)
- Devoted GIVEBACK Florida (HMO)
- Devoted PREMIUM Florida (HMO)
- Devoted SELECT Florida (HMO)
Georgia
Hawaii
- Devoted CHOICE Hawaii (PPO) - Honolulu & Kauai
- Devoted CHOICE Hawaii (PPO) - Hawaii & Maui
- Devoted CHOICE GIVEBACK Hawaii (PPO) - Honolulu & Kauai
- Devoted CHOICE GIVEBACK Hawaii (PPO) - Hawaii & Maui
- Devoted CHOICE PLUS Hawaii (PPO) - Honolulu & Kauai
- Devoted CHOICE PLUS Hawaii (PPO) - Hawaii & Maui
Illinois
- Devoted CHOICE Illinois (PPO)
- Devoted CHOICE GIVEBACK Illinois (PPO)
- Devoted CORE Illinois (HMO)
- Devoted GIVEBACK Illinois (HMO)
Indiana
Kentucky
Mississippi
- Devoted CHOICE Mississippi (PPO)
- Devoted CHOICE DUAL Mississippi (PPO D-SNP)
- Devoted CHOICE DUAL PLUS Mississippi (PPO D-SNP)
- Devoted CHOICE GIVEBACK Mississippi (PPO)
Missouri
- Devoted CORE Missouri (HMO)
- Devoted DUAL Missouri (HMO D-SNP)
- Devoted DUAL PLUS Missouri (HMO D-SNP)
- Devoted GIVEBACK Missouri (HMO)
North Carolina
- Devoted CHOICE North Carolina (PPO)
- Devoted CHOICE GIVEBACK North Carolina (PPO)
- Devoted CORE North Carolina (HMO)
- Devoted DUAL North Carolina (HMO D-SNP)
- Devoted DUAL PLUS North Carolina (HMO D-SNP)
- Devoted GIVEBACK North Carolina (HMO)
Ohio
- Devoted CHOICE Ohio (PPO)
- Devoted CHOICE EXTRA Ohio (PPO)
- Devoted CORE Ohio (HMO)
- Devoted DUAL Ohio (HMO D-SNP)
- Devoted DUAL PLUS Ohio (HMO D-SNP)
- Devoted GIVEBACK Ohio (HMO)
- Devoted PREMIUM Ohio (HMO)
Oregon
- Devoted CHOICE Oregon (PPO)
- Devoted CHOICE PLUS Oregon (PPO)
- Devoted CORE Oregon (HMO) - Clackamas, Columbia, Multnomah, and Washington counties
- Devoted CORE Oregon (HMO) - Lane, Lincoln, and Linn counties
- Devoted GIVEBACK Oregon (HMO)
- Devoted PREMIUM Oregon (HMO)
Pennsylvania
- Devoted CHOICE Pennsylvania (PPO) - Armstrong, Bedford, Blair, Carbon, Clarion, Clearfield, Clinton, Crawford, Elk, Forest, Fulton, Huntingdon, Jefferson, Lackawanna, Lawrence, Luzeme, Monroe, Somerset, Susquehanna, and Wyoming counties
- Devoted CHOICE Pennsylvania (PPO) - Berks, Bucks, Chester, Delaware, Lehigh, Montgomery, Northampton, and Philadelphia counties
- Devoted CHOICE GIVEBACK Pennsylvania (PPO) - Armstrong, Bedford, Blair, Carbon, Clarion, Clearfield, Clinton, Crawford, Elk, Forest, Fulton, Huntingdon, Jefferson, Lackawanna, Lawrence, Luzeme, Monroe, Somerset, Susquehanna, and Wyoming counties
- Devoted CHOICE GIVEBACK Pennsylvania (PPO) - Berks, Bucks, Chester, Delaware, Lehigh, Montgomery, Northampton, and Philadelphia counties
- Devoted CHOICE PLUS Pennsylvania (PPO)
- Devoted CORE Pennsylvania (HMO)
- Devoted DUAL PLUS Pennsylvania (HMO D-SNP)
- Devoted GIVEBACK Pennsylvania (HMO)
South Carolina
- Devoted CORE South Carolina (HMO)
- Devoted CHOICE South Carolina (PPO)
- Devoted CHOICE GIVEBACK South Carolina (PPO)
- Devoted PREMIUM South Carolina (HMO)
Tennessee
- Devoted BE WELL PLUS Tennessee (HMO C-SNP)
- Devoted CHOICE Tennessee (PPO) - Fayette, Hardeman, Haywood, and Shelby counties
- Devoted CHOICE Tennessee (PPO) - all counties except Fayette, Hardeman, Haywood, and Shelby counties
- Devoted CHOICE GIVEBACK Tennessee (PPO) - Fayette, Hardeman, Haywood, and Shelby counties
- Devoted CHOICE GIVEBACK Tennessee (PPO) - all counties except Fayette, Hardeman, Haywood, and Shelby counties
- Devoted CORE Tennessee (HMO)
- Devoted GIVEBACK Tennessee (HMO)
Texas
- Devoted BE WELL San Antonio (HMO C-SNP)
- Devoted CHOICE Austin (PPO)
- Devoted CHOICE GIVEBACK Austin (PPO)
- Devoted CORE Austin (HMO)
- Devoted CORE El Paso (HMO)
- Devoted CORE Greater Houston (HMO)
- Devoted CORE San Antonio (HMO)
- Devoted DUAL PLUS Austin (HMO D-SNP)
- Devoted DUAL PLUS El Paso (HMO D-SNP)
- Devoted DUAL PLUS Greater Houston (HMO D-SNP)
- Devoted DUAL PLUS San Antonio (HMO D-SNP)
- Devoted EXTRA Greater Houston (HMO)
- Devoted EXTRA San Antonio (HMO)
- Devoted GIVEBACK El Paso (HMO)
- Devoted GIVEBACK Greater Houston (HMO)
- Devoted GIVEBACK San Antonio (HMO)
- Devoted PREMIUM Greater Houston (HMO)