About our Formulary

Saint Mary's ATRIO Health plans use a comprehensive formulary. A comprehensive formulary is a complete list of covered drugs selected by Saint Mary's ATRIO Health Plans in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Saint Mary's ATRIO Health Plans will generally cover the drugs listed in our formulary as long as the drug is medically necessary, and certain other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage (Member Handbook).

Can the Formulary change?

The formulary may change at any time. You will receive notice when necessary. Generally, if you are taking a drug on the current plan year formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the rest of the coverage year. Exceptions are made when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you choose our plan, except for cases in which you can save additional money or we need to act to ensure your safety.

If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy restrictions on a drug, we will notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.