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Providers

Formularies

Review the generic and brand-name drugs covered by our plans.

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Contents:

We update our online formularies regularly.

You can search by drug name or category and download as a PDF.

2025 Formulary

Plans Online Link  PDF Version Comments 

Jefferson Health Plans Medicare Advantage

Premium Formulary:
Special, Dual Pearl

 Search Online Download 
Updated 1/1/2025		  

Jefferson Health Plans Medicare Advantage

Core Formulary: 
Prime, Complete, Silver, Platinum, Flex Plus, Flex Pro

 Search Online Download
Updated 1/1/2025		  

Jefferson Health Plans Medicare Advantage

Value Formulary:
Giveback, Flex, Choice, Choice Plus

 Search Online Download
Updated 1/1/2025		  
Health Partners Plans Medicaid
PDL and Supplemental Formulary		 Search Online Download
  
CHIP Search Online Download 
Updated 01/2025		  
Jefferson Health Plans Individual and Family Plans Search Online Download 
Updated 1/2025		 Change History
(Updated December 2024)

2024 Formulary

Plans Online Link  PDF Version Comments 

Jefferson Health Plans Medicare Advantage

Pennsylvania: HMO-POS & PPO
Prime (HMO-POS)
Complete (HMO-POS) 
Giveback (HMO-POS) 
Flex (PPO)  
Flex Plus (PPO) 

New Jersey: HMO-POS 
Silver (HMO-POS)  
Platinum (HMO-POS) 

 Search Online Download 
Updated 12/1/2024		 Change History
(Updated December 2024)

Jefferson Health Plans Medicare Advantage

Pennsylvania: D-SNP 
Special (HMO SNP) Dual Pearl (HMO SNP) 

 Search Online Download
Updated 12/1/2024		 Change History
(Updated December 2024)
Health Partners Plans Medicaid
PDL and Supplemental Formulary		 Search Online Download
  
CHIP Search Online Download 
Updated 10/2024		  
Jefferson Health Plans Individual and Family Plans Search Online Download 
Updated 9/2024		 Change History
(Updated December 2024)

Additional Resources

P&T Committee

The Pharmacy and Therapeutics (P&T) Committee has reviewed and approved the formularies. Review the most recent P&T Committee meeting summary minutes:

Prior Authorization

Click here to request drugs requiring prior authorization or non-formulary drugs

Printed Formularies

Call the Provider Services Helpline at  1-888-991-9023 to request a printed copy of our formularies.

Health Partners (Medicaid), CHIP and Jefferson Health Plans IFP Formulary Updates
Frequently Asked Questions

We offer 90-day prescriptions for inexpensive, chronic medications for all members. However, we encourage 100-day prescriptions for Medicare members who have chronic conditions. Our members usually can save time and money with extended day prescriptions, which can impact compliance with their medication regimen. Special pricing is available through network pharmacies and our mail order program. Note: extended day supplies are not available for specialty drugs.

A drug recall list can be found on the FDA's website. Any members affected will receive a drug recall from Jefferson Health Plans.

Please submit these requests in writing to the pharmacy department. Requests for additions to the formulary will be reviewed by the P&T Committee.

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