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Non-Medicare Prescription Plan - CVS Caremark

Formulary (Covered & Non-Covered Drugs)

A formulary is a list of drugs covered under your prescription plan, and includes both generic and brand name. Drugs that are not covered are considered non-formulary. Products that are not FDA approved will not appear on the formulary, and products recently approved may not be covered on the formulary upon immediate release to the market. In addition, the dosage and administration for drugs on the formulary list will follow current FDA guidance and recommendations. Learn More.

Plan Level Exclusions

Drugs on the State of Delaware Prescription Drug Plan Level Exclusion  list are not covered under the State of Delaware Prescription Plan, regardless if they appear on the CVS Caremark Formulary of covered drugs. These excluded drugs are not eligible for consideration under the Coverage Review program. These include, but are not limited to:

  • Prescriptions drugs that have OTC equivalents
  • Weight Loss Medications
  • Blood Glucose Monitors not issued by Livongo®

CVS Caremark Formulary Information

The following documents provide a list of covered and not-covered drugs under your prescription plan effective April 1, 2022:

The following documents provide a list of covered and not-covered drugs under your prescription plan effective July 1, 2022:

If an excluded medication is medically necessary, you may initiate a Coverage Review.

*These medications require a prior authorization due to a formulary exclusion; other clinical prior authorizations may still apply.






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