A formulary is a list of drugs that CoventryCares of Kentucky covers. The list includes prescription drugs and some over-the-counter (OTC) medicines. We have provided the formulary below in two ways. One list is arranged by the alphabet (Alpha Formulary) and the other list arranged by class of drug (Class Formulary).

Formulary Documents

Alpha Formulary 2013 PDF | 84KB: This is a list of the drug formulary in alphabetical order

Class Formulary 2013 PDF | 125KB: This is a list of the drug formulary arranged by drug class

Prior Authorization Forms

General Prior Auth/Non-Formulary Medication PDF | 32KB: Rx Prior Authorization

Non-Formulary ADD/ADHD Therapies PDF | 32KB: Rx Pre Auth Forms

Non-Formulary Antidepressant PDF | 32KB: Rx NF Forms

Non-Formulary Atypical Antipyschotics PDF | 32KB: Rx Pre-Auth

Non-Formulary Fibromyalgia Therapies PDF | 32KB: Rx Pre Auth

Non-Formulary Opioid Narcotics PDF | 32KB: Rx Pre Auth

Non-Formulary PPI or High Dose PPI PDF | 31KB: Rx Pre-Auth

Singulair (montelukast) Prior Auth Form PDF | 29KB: Rx Pre Auth

Suboxone (buprenorphine/naloxone) Prior Auth Form PDF | 37KB: Rx Pre Auth

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