By Alphabet
Select a letter to view drugs starting with that letter
By Therapeutic Class
Please select a therapy class to continue
- A
- ADRENERGIC AGENTS
- ALPHA-ADRENERGIC BLOCKING AGENT(SYMPATH)
- ANALGESICS AND ANTIPYRETICS
- ANOREXIGENIC AGENTS
- ANOREXIGENICS;RESPIRATORY,CNS STIMULANTS
- ANTI-INFECTIVE AGENTS
- ANTI-INFECTIVES (EENT)
- ANTI-INFECTIVES (SKIN, MUCOUS MEMBRANE)
- ANTI-INFLAMMATORY AGENTS (EENT)
-
ANTI-INFLAMMATORY AGENTS (RESPIRATORY)
- ALPHA- AND BETA-ADRENERGIC AGONISTS
- ALPHA-ADRENERGIC AGONISTS
- ALPHA-ADRENERGIC BLOCKING AGENT(SYMPATH)
- ANTITHYROID AGENTS
- CONTRACEPTIVES (E.G. FOAMS, DEVICES)
- DENTAL AGENTS
- DISINFECTANTS (FOR NON-DERMATOLOGIC USE)
- ENZYMES
- GLYCYLCYCLINES
- INTERLEUKIN ANTAGONISTS
- KETONES
- LEUKOTRIENE MODIFIERS
- MAST-CELL STABILIZERS
- MULTIVITAMIN PREPARATIONS
- NITRATES AND NITRITES
- OCCULT BLOOD
- OXYTOCICS
- PH
- PHOSPHODIESTERASE TYPE 5 INHIBITORS
- PROTEIN
- SOMATOTROPIN AGONISTS
- SOMATOTROPIN ANTAGONISTS
- SUGAR
- THYROID AGENTS
- UNCLASSIFIED
- VASODILATING AGENTS, MISCELLANEOUS
- VITAMIN A
- VITAMIN B COMPLEX
- VITAMIN C
- VITAMIN C
- VITAMIN D
- VITAMIN E
- VITAMIN K ACTIVITY
- ANTIANEMIA DRUGS
- ANTIARRHYTHMIC AGENTS
- ANTIBACTERIALS
- ANTIBACTERIALS, MISCELLANEOUS
- ANTICHOLINERGIC AGENTS
- ANTICOAGULANTS
- ANTICONVULSANTS
- ANTIDEPRESSANTS
- ANTIDIABETIC AGENTS
- ANTIEMETICS
- ANTIFUNGAL (SYSTEMIC)
- ANTIFUNGALS (SKIN AND MUCOUS MEMBRANE)
- ANTIGLAUCOMA AGENTS
- ANTIHEMORRHAGIC AGENTS
- ANTIHISTAMINE DRUGS
- ANTIHISTAMINES (RESPIRATORY TRACT AGNTS)
- ANTIHYPOGLYCEMIC AGENTS
- ANTILIPEMIC AGENTS
- ANTIMIGRAINE AGENTS
- ANTIMYCOBACTERIALS
- ANTINEOPLASTIC AGENTS
- ANTIPARKINSONIAN AGENTS (CNS)
- ANTIPROTOZOALS
- ANTIPSYCHOTIC AGENTS
- ANTIRETROVIRALS
- ANTITHROMBOTIC AGENTS
- ANTITOXINS,IMMUNE GLOB,TOXOIDS,VACCINES
- ANTIULCER AGENTS AND ACID SUPPRESSANTS
- ANTIVIRALS (SYSTEMIC)
- ANXIOLYTICS, SEDATIVES AND HYPNOTICS
- AUTONOMIC DRUGS
- B
- BETA-3-ADRENERGIC AGONISTS
- BETA-ADRENERGIC AGONISTS
- BETA-ADRENERGIC BLOCKING AGENTS(SYMPATH)
- BLOOD DERIVATIVES
- BLOOD FORMATION, COAGULATION, THROMBOSIS
- BRONCHODILATORS
- C
- CALCIUM-CHANNEL BLOCKING AGENTS
- CALCIUM-CHANNEL BLOCKING AGENTS(HYPOTEN)
- CARDIAC DRUGS
- CARDIOVASCULAR DRUGS
- CELLULAR AND GENE THERAPY
- CENTRAL NERVOUS SYSTEM AGENTS
- CEPHALOSPORINS
- CONTRACEPTIVES (E.G. FOAMS, DEVICES)
- CORTICOSTEROIDS (RESPIRATORY TRACT)
- CYSTIC FIBROSIS (CFTR) MODULATORS
- D
- DENTAL AGENTS
- DEPIGMENTING AND PIGMENTING AGENTS
- DEVICES
-
DIAGNOSTIC AGENTS
- ADRENOCORTICAL INSUFFICIENCY
- ALLERGENIC EXTRACTS (DIAGNOSTIC)
- CARDIAC FUNCTION
- DIABETES MELLITUS
- DIAGNOSTIC AGENTS
- DRUG HYPERSENSITIVITY
- FUNGI
- GALLBLADDER FUNCTION
- INTESTINAL ABSORPTION
- KIDNEY FUNCTION
- LIVER FUNCTION
- LYMPHATIC SYSTEM
- MYASTHENIA GRAVIS
- OCULAR DISORDERS
- PANCREATIC FUNCTION
- PITUITARY FUNCTION
- RESPIRATORY FUNCTION
- ROENTGENOGRAPHY
- THYROID FUNCTION
- TUBERCULOSIS
- URINE AND FECES CONTENTS
- DISINFECTANTS (FOR NON-DERMATOLOGIC USE)
- DIURETICS
- DIURETICS (HYPOTENSIVE AGENTS)
- DOPAMINE RECEPTOR AGONISTS
- E
- ELECTROLYTIC, CALORIC, AND WATER BALANCE
- EMOLLIENTS, DEMULCENTS, AND PROTECTANTS
- ENZYMES
- ESTROGENS AND ANTIESTROGENS
- EYE, EAR, NOSE AND THROAT (EENT) PREPS.
- F
- FIRST GENERATION ANTIHISTAMINES
- G
- GASTROINTESTINAL DRUGS
- GENERAL ANESTHETICS
- GENITOURINARY SMOOTH MUSCLE RELAXANTS
- GOLD COMPOUNDS
- GONADOTROPINS AND ANTIGONADOTROPINS
- H
- HCV ANTIVIRALS
- HEAVY METAL ANTAGONISTS
- HORMONES AND SYNTHETIC SUBSTITUTES
- HYPOTENSIVE AGENTS
- I
- ION-REMOVING AGENTS
- L
- LOCAL ANESTHETICS (PARENTERAL)
- M
- MACROLIDES
- MISCELLANEOUS B-LACTAM ANTIBIOTICS
-
MISCELLANEOUS THERAPEUTIC AGENTS
- 5-ALPHA-REDUCTASE INHIBITORS
- ALCOHOL DETERRENTS
- ANTIDOTES
- ANTIGOUT AGENTS
- ANTISENSE OLIGONUCLEOTIDES
- BONE RESORPTION INHIBITORS
- CARBONIC ANHYDRASE INHIBITORS (MISC.)
- CARIOSTATIC AGENTS
- COMPLEMENT INHIBITORS
- DISEASE-MODIFYING ANTIRHEUMATIC AGENTS
- IMMUNOMODULATORY AGENTS
- IMMUNOSUPPRESSIVE AGENTS
- OTHER MISCELLANEOUS THERAPEUTIC AGENTS
- PROTECTIVE AGENTS
- N
- NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
- O
- OXYTOCICS
- P
- PARATHYROID AND ANTIPARATHYROID AGENTS
- PENICILLINS
- PHARMACEUTICAL AIDS
- R
- RADIOACTIVE AGENTS
- RENIN-ANGIOTENSIN-ALDOSTER.INHIB(HYPOTN)
- RENIN-ANGIOTENSIN-ALDOSTERONE SYS. INHIB
- RESPIRATORY TRACT AGENTS
- S
- SKELETAL MUSCLE RELAXANTS
-
SKIN AND MUCOUS MEMBRANE AGENTS
- ANTI-INFECTIVES (SKIN, MUCOUS MEMBRANE)
- ANTI-INFLAMMATORY AGENTS (SKIN, MUCOUS)
- ANTIPRURITICS AND LOCAL ANESTHETICS
- ASTRINGENTS
- CELL STIMULANTS AND PROLIFERANTS
- DEPIGMENTING AND PIGMENTING AGENTS
- DETERGENTS
- EMOLLIENTS, DEMULCENTS, AND PROTECTANTS
- KERATOLYTIC AGENTS
- KERATOPLASTIC AGENTS
- SKIN AND MUCOUS MEMBRANE AGENTS, MISC.
- SUNSCREEN AGENTS
- SMOOTH MUSCLE RELAXANTS
- SOMATOSTATIN AGONISTS AND ANTAGONISTS
Legend
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T1Preferred
-
T2Non-Preferred
-
T3NON-PDL
-
NCNot-Covered
Upper Peninsula Health Plan - Duals
Welcome
We cover both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
What is a Formulary?
A formulary is a list of covered drugs which represents the prescription therapies believed to be a necessary part of a quality treatment program. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage. The format of our formulary follows the regulations and guidance provided by the Centers for Medicare & Medicaid Services (CMS).
Printable Files
The following files require Adobe Acrobat. Download Adobe Acrobat
- Printable Preferred Drug List
- Quantity Limit
- Prior Authorization
- Formulary Change History
- Machine Readable Drugs JSON