Please select the desired PDL from the options provided below. Depending on the software you have installed on your computer, you will also need to select the appropriate format.
If you cannot view a file, please download the appropriate free plug-in: MS Word Viewer (.doc or .rtf), MS Excel Viewer (.xls), Acrobat Viewer (.pdf)
Additional PDL News & Info
- Diabetic Supply List - effective 5/1/2025
- Over the Counter Rebate List - effective 7/1/2025
- 15-Day Initial Fill List - effective 07/1/2025
- 90-Day Maintenance Drug List - effective 7/1/2025
- Cash Waiver Form
- Reversal Form
Archive
- Preferred Drug List - As of 4/4/2025 - Excel
- Preferred Drug List - As of 4/4/2025 - PDF
- Preferred Drug List - As of 1/24/2025 - Excel
- Preferred Drug List - As of 1/24/2025 - PDF
- Preferred Drug List - As of 1/1/2025 - Excel
- Preferred Drug List - As of 1/1/2025 - PDF
- Preferred Drug List - As of 11/8/2024 - Excel
- Preferred Drug List - As of 11/8/2024 - PDF
- Preferred Drug List - As of 8/12/ 2024
- Preferred Drug List - As of 2/2/ 2024
- Diabetic Supply List - effective 4/1/2025
- Diabetic Supply List - effective 1/1/2025
- Diabetic Supply List - effective 10/1/2024
- Diabetic Supply List - effective 7/31/2024
- Diabetic Supply List - effective 1/1/2024
- Over the Counter Rebate List - effective 4/1/2025
- Over the Counter Rebate List - effective 1/6/2025
- Over the Counter Rebate List - effective 9/15/2023