Erickson Advantage Formulary

You will find the Erickson Advantage formulary and drug utilization management when you click on the link below.

When you click this link—2020 Drug Formulary— PDF opens in a new window you will be taken to the OptumRx formulary (the list of drugs covered under Erickson Advantage). The Erickson Advantage formulary and OptumRx formulary are the same. You will also find the Step Therapy Criteria and Prior Authorization Criteria on OptumRx.

Download and print the Erickson Advantage 2020 Comprehensive Formulary Champion PlanPDF opens in a new window | Spanish Language Version PDF opens in a new window

Download and print the Erickson Advantage 2020 Comprehensive Formulary Freedom, Guardian, Liberty with Drugs, Signature with DrugsPDF opens in a new window | Spanish Language Version PDF opens in a new window

Or view the pdf below.

Erickson Advantage Drug Management

Click the links below to download your necessary documents.

• 2020 Pharmacy Directory,English 2020 Pharmacy Directory - PDF opens in a new window | Spanish 2020 Pharmacy Directory -PDF opens in a new window
• Prescription Drug Transition Process PDF opens in a new window
• Medication Therapy Management PDF opens in a new window
• Personal Medication Form PDF opens in a new window
• Coverage Determinations, Appeals and Grievances PDF opens in a new window
• Redetermination Request Form PDF opens in a new window
• CMS Prescription Drug Determination Request Form PDF opens in a new window
• Medication Prior Authorization Request Criteria PDF opens in a new window
• Step Therapy Criteria PDF opens in a new window
• Appointment of Authorized Representative Form PDF opens in a new window
• Privacy Notice under the HIPAA Privacy Rule PDF opens in a new window
• Mail Order Pharmacy PDF opens in a new window

^*The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

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