ᏣᎮᏍᏗ ᏗᏣᏓᏛᏗ ᏄᏰᎵᏛ ᎢᏳᏍᏗ ᏅᏬᏘᏃ ᎨᏒᎢ ᎠᏚᏓᎸᏙᏗ ᎬᏗ ᏣᏤᎵ ᎠᏍᏓᏩᏛᏍᏗ? ᎠᏴᏍᏗ ᏣᏤᎵ ᏂᏕᎬᏅᎢ ᏂᏗᎬᏁᏗ ᏕᎦᏟᏌᎲᎢ ᎠᏂ ᎠᎴᏃ ᎠᏱᏍᏗ ᎠᎩᏍᏗ ᎤᏴᏍᏗ ᎤᎶᏒ ᎾᏍᎩ ᎠᏱᏍᏗ ᎬᏔᏂᏓᏍᏗ.
ᎠᏓᏃᎯᏎᎯ ᎦᏁᏟᏴᏍᏗ
ᎤᏓᎷᎸᎢ ᎠᎵᏍᎪᎸᏗᏍᎩ
ᎠᎳᏍᎬᏓ ᏗᎨᏥᏅᏬᏗ
2026 Alternative Covered Drugs
Preferred diabetes testing supplies list (blood glucose meters and test strips) you can receive from an in-network pharmacy for plan year 2025. Last Updated 08/01/25.
Members can complete this form to order prescriptions from Express Scripts® Pharmacy.
Members can complete this form to order prescriptions from Express Scripts® Pharmacy.
View common drugs not covered by the plan, along with alternative drugs that are covered.
ᎯᎠ ᎪᏪᎳᏅᎢ ᏓᏍᏓᏅᏃᏛᎢ ᏣᏤᎵ ᏄᏓᎴᏒ ᏗᏣᏤᎵᎦᏯ ᎬᏗ ᏗᎬᏩᎵ ᎾᎢ ᏣᏤᎵ Medicare ᎠᎩᏍᏗ ᎤᏴᏍᏗ ᎠᏍᏓᏩᏛᏍᏗ.
ᎯᎧᎵᏏᏍᏌ ᎯᎠ ᎠᎧᎵᏏᏐᏗ ᎾᎢ ᎠᏔᏲᏍᏗ ᏂᎦᏓ ᎨᎦᏈᏴᎡᏓ ᎾᏍᎩᎾ ᏣᏚᏓᎸᏛᎢᎠᏓᏅᏍᏙᏗ ᏗᎩᏍᏗ ᏧᏴᏍᏗ ᎾᏍᎩᎾᎢ ᏂᎯ ᏣᏈᏴᏓ ᎧᎵᎢ ᏓᎬᏩᎶᏛᎢ ᎾᏍᎩᎾᎢ.
Complete this printable form to ask us for a decision about a prescription drug and your specific plan coverage. Members should fax form to 1-866-388-1767.
Complete this printable form to ask for an appeal after being denied a request for coverage or payment for a prescription drug.
