What you need to know about this formulary information:
Formulary status may vary and is subject to change. Formulary coverage does not imply clinical efficacy or safety. This is not a guarantee of partial or full coverage or payment. Consumers may be responsible for varying out-of-pocket costs based on an individual’s plan and its benefit design. Each plan administrator determines actual benefits and out-of-pocket costs per its plan’s policies.
Verify coverage with plan sponsor or Centers for Medicare & Medicaid Services (CMS). Medicare Part D patients may obtain coverage for products not otherwise covered via the medical necessity process.