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Drug Formulary

Passport Health Plan

Online Drug Formulary

Learn How to Find Your Medicine

Call Us with Questions

Passport Advantage

Passport Advantage Online Drug Formulary

Learn How to Find Your Medicine: PAD

Call Us with Questions: PAD

Additional Formulary Resources

Request for Drug List Review (PDF)

Over the Counter Drug List (PDF)

Alphabetical Preferred Prenatal Vitamin NDCs List (PDF)

Criteria for Child Psychiatrist on the Use of Selected Psychotropic Medications (PDF)

Criteria for Child Psychiatrist on the Use of Selected Psychotropic Medications - Appendix A: Explanation of Terms and Conditions (PDF)

Criteria for Child Psychiatrist on the Use of Selected Psychotropic Medications - Appendix B: Passport Health Plan Approved ICD-9 Codes (PDF)

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