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Formulary Drug Search

Last updated on 04/01/2021

To see if your prescription is covered by our plan, please type in the name of the drug below. You may also search by tier to see a list of drugs per tier.

Formulary Drug List for the following plan:

Clear Spring Health Select (HMO)
Last Updated: 04/01/2021

Prior Authorization Criteria

Step Therapy Criteria

Formulary Drug List for the following plan:

Clear Spring Health Choice (PPO)
Last Updated: 04/01/2021

Prior Authorization Criteria

Step Therapy Criteria

Formulary Drug List for the following plan:

Clear Spring Health Deluxe (HMO SNP)
Last Updated: 04/01/2021

Prior Authorization Criteria

Step Therapy Criteria

Formulary Drug List for the following plan:

Clear Spring Health Silver (HMO SNP)
Last Updated: 04/01/2021

Prior Authorization Criteria

Step Therapy Criteria

Formulary Drug List for the following plan:

Clear Spring Health Select Plus (HMO)
Last Updated: 04/01/2021

Prior Authorization Criteria

Step Therapy Criteria

Formulary Drug List for the following plan:

Clear Spring Health Gold Plus (PPO)
Last Updated: 04/01/2021

Prior Authorization Criteria

Step Therapy Criteria

* This drug may be covered under Medicare Part B or Part D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination.

Mail order is available for formulary drugs that have a 90-day supply fill option.

Coverage Requirements

For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. This ensures our members use these drugs in a safe way. The types of additional requirements are listed below:

Prior Authorization – For certain drugs, your doctor will need to contact us before you can fill your prescription. Prior Authorization means that you or your provider will need to get approval from us before filling the prescriptions. If members don’t get approval, Eon Health may not cover the drug.

Quantity Limits – For certain drugs, our plan limits the amount of the drug that we will cover. For example, we provide 60 tablets per prescription per 30 days for metformin 1000 mg tablets. This may be in addition to a standard one-month or three-month supply.

Step Therapy – For certain drugs, we require you to first try another drug to treat your medical condition before we will cover the drug your physician initially prescribed. For example, if Drug A and B both treat your medical condition, Eon Health may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Eon Health will then cover Drug B.

Can I receive coverage for drugs not on the formulary?

Yes, if you believe you are entitled to payment or benefits on a certain drug, you can request a Coverage Determination. A coverage determination is a decision made by Eon Health regarding payment for a Part D drug or exceptions to our formulary. Please use the coverage determination request form below:

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Clear Spring Health has a contract with Medicare to offer PPO, HMO, and PDP Plans. Eon Health has a contract with the Georgia Medicaid program and a contract with the South Carolina Medicaid program. Enrollment in these plans depends on contract renewal. Clear Spring Health Deluxe (HMO SNP): This plan is available to anyone who has both Medicare and received assistance from the State. Clear Spring Health Silver (HMO SNP): This plan is available to anyone with Medicare who has been diagnosed with Cardiovascular Disorder, Chronic Heart Failure or Diabetes. Eon Health has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until December 31, 2022 based on a review of Eon Health’s Model of Care. This information is not a complete description of benefits. Contact the plan for more information. Limitations, Copayments, and restrictions may apply. Benefits, formulary, pharmacy/provider network, premium and cost sharing may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Premiums, co-pays/co-insurance may vary based on the level of Extra Help you receive. Please contact the plan for further details. Medicare beneficiaries may also enroll in Eon Health through the CMS Medicare Online Enrollment Center located at www.medicare.gov. The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary. Clear Spring Health Choice (PPO): Out of network/non-contracted providers are under no obligation to treat Eon Health members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask for a pre-service organization determination before you receive the service. Please call our customer service or see your Evidence of Coverage for more information, including cost-sharing that applies to out-of-network services.