A formulary is a list of covered drugs selected by MetroPlus which represents the prescription therapies believed to be a necessary part of a quality treatment program. MetroPlus will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a MetroPlus network pharmacy, and other plan rules are followed. Check your benefit materials for more specific information or call us if you have any questions. 


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Lines of Business Document Effective Date
Marketplace Plans (Individual)
Marketplace Plans (SHOP)
Essential Plan 
STEP Criteria
March 2017
MetroPlus Gold Formulary February 2017
MetroPlus GoldCare I & II Formulary February 2017
Child Health Plus
Partnership In Care (SNP)
MetroPlus Enhanced (HARP)
Quick Reference Guide
February 2017
Medicare 2017 Comprehensive Formulary
STEP Criteria
Prior Authorization
Part B Diabetes Monitoring Device and Supply Policy
March 2017

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MetroPlus FIDA Participant Comprehensive Formulary 
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MetroPlus FIDA Prior Authorization 
MetroPlus FIDA STEP Criteria 
MetroPlus FIDA Part B Diabetes Monitoring Device and Supply Policy

Updated 03/2017


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