Drug Name Search
Enter a drug name to begin
By Alphabet
Select a letter to view drugs starting with that letter
A
B
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By Therapeutic Category
Please select a therapy class to continue
Legend
T1
Generics
T2
Brands
NF
Non-Formulary
QL
Quantity Limit
ST
Step Therapy
PA
Prior Authorization
PA
2
Prior Authorization
(New Starts Only)
PA
3
Prior Authorization
(Part B vs. Part D)
S
Specialty Drug
BD
Covered under Medicare Part B or D
*
Non-Part D drugs or OTC items that are covered by Medicaid
(g)
Only the generic version of this drug is covered. The brand name version is not covered.
M
The brand name version of this drug is in Tier 2. The generic version is in Tier 1
BRAND NAMES
generic names
Upper Peninsula MI Health Link (2017)
Welcome
We cover both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
What is a Formulary?
A formulary is a list of covered drugs which represents the prescription therapies believed to be a necessary part of a quality treatment program. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.
Printable Files
The following files require Adobe Acrobat, click here to download it now
Printable Formulary
Printable Formulary (Large Print)
Quantity Limit
Prior Authorization
Step Therapy
Formulary Change History
How to Search For Drugs
  • Use the alphabetical list to search by the first letter of your medication.
  • Search by typing part of the generic (chemical) and brand (trade) names.
  • Search by selecting the therapeutic class of the medication you are looking for.
  • How to Request an Exception
    You can ask us to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make:
  • You can ask us to cover your drug even if it is not on our formulary.
  • You can ask us to waive coverage restrictions or limits on your drug.
  • You can ask us to provide a higher level of coverage for your drug.

  • You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception. When you are requesting a formulary, tiering or utilization restriction exception you should submit a statement from your physician supporting your request. Generally, we must make our decision within 72 hours of getting your prescribing physician’s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we get your prescribing physician’s supporting statement.