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Providers

Formularies

Review the generic and brand-name drugs covered by our plans.

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Contents:

We update our online formularies regularly.

You can search by drug name or category and download as a PDF.

Jefferson Health Plans Medicare Advantage
Premium Formulary

Special, Dual Pearl, Select

Updated 2/1/2026

Updated 2/1/2026

Core Formulary

Prime, Complete, Silver, Elite, Flex Plus, Flex Pro, Choice

Updated 2/1/2026

Updated 2/1/2026

Value Formulary

Giveback, Flex, Choice Plus

Updated 2/1/2026

Updated 2/1/2026

Individual and Family Plans
Formulary

Updated 11/1/2025

Updated 12/9/2025

CHIP
Formulary

Updated 1/1/2026

Medicaid
PDL and Supplemental Formulary

Updated 1/1/2026

2025 Formulary

Plans Online Link  PDF Version Comments 

Jefferson Health Plans Medicare Advantage

Premium Formulary:
Special, Dual Pearl

 Search Online Download
Updated 12/1/2025		 Change History
Updated 12/1/2025

Jefferson Health Plans Medicare Advantage

Core Formulary: 
Prime, Complete, Silver, Platinum, Flex Plus, Flex Pro

 Search Online Download
Updated 12/1/2025		 Change History
Updated 12/1/2025

Jefferson Health Plans Medicare Advantage

Value Formulary:
Giveback, Flex, Choice, Choice Plus

 Search Online Download
Updated 12/1/2025		 Change History
Updated 12/1/2025
Health Partners Plans Medicaid
PDL and Supplemental Formulary		 Search Online Download
  
CHIP Search Online Download
Updated 9/29/2025		  
Jefferson Health Plans Individual and Family Plans Search Online Download
Updated 10/2025		 Change History
Updated 10/1/2025

Additional Resources

P&T Committee

The Pharmacy and Therapeutics (P&T) Committee has reviewed and approved the formularies. Review the most recent P&T Committee meeting summary minutes:

Medicaid (October 2025)

Medicare (October 2025)

Individual & Family Plans (October 2025)

Prior Authorization

Click here to request drugs requiring prior authorization or non-formulary drugs

Printed Formularies

Call the Provider Services Helpline at  1-888-991-9023 to request a printed copy of our formularies.

Specialty Medications and Pharmacies

Specialty medications are prescription drugs that require special handling, administration or monitoring. They are used to treat complex, chronic and often costly conditions such as cancer, rheumatoid arthritis and hemophilia. and are only available from a specialty pharmacy. 

View list of Specialty Medications.

Specialty Pharmacy Network

Jefferson Health Plans uses a contract network of specialty pharmacies to coordinate the care and delivery of specialty medications.

The pharmacies below are in the Jefferson Health Plans (Medicaid and CHIP) specialty pharmacy network.

Accredo Health Group

3000 Ericsson Drive 
Suite 100
Warrendale, PA 15086
Phone: 877-720-7445
Fax: 866-768-2998

 

Apovia Pharmacy Services

313 Henderson Drive
Sharon Hill, PA 19079
Phone: 267-901-0000
Fax: 267-546-4324

 

Banks Apothecary Specialty Pharmacy

3800 Horizon Blvd. 
Suite 103
Trevose, PA 19053
Phone: 215-494-9403
Fax: 215-357-2129

 

Coordinated Care Network Pharmacy

300 Penn Center Blvd.  
Suite 405  
 PA 15235
Phone: 412-349-6300
Fax: 412-349-6724 

Cure Stat Rx Home Infusion and Specialty Pharmacy

6725 Mesa Ridge Road
Suite 230
San Diego, CA 92121
Phone: 888-963-6544
Fax: 858-281-0045

 

CVS Specialty Pharmacy

1117 Walnut Street  
Philadelphia, PA 19107
Phone: 866-813-3899
Fax: 215-627-8943

 

Elwyn Specialty Care

3070 McCann Farm Drive  
Garnet Valley, PA 19060
Phone: 610-545-6040
Fax: 610-545-6030

 

Ganse Apothecary

355 W King Street
Lancaster, PA 17603
Phone: 717-394-5671 
Fax: 717-427-1632

 

Genoa Pharmacy, LLC

807 Lawn Ave, Suite 104
Sellersville, PA 18960
Phone: 267-354-8166
Fax: 267-443-1334

Jefferson Specialty Pharmacy

3500 Horizon Drive  
King of Prussia, PA 19406
Phone: 215-955-8154
Fax: 215-955-8182

 

LifeTree Pharmacy

5 Blue Heron Drive  
Collegeville, PA 19426
Phone: 610-489-6640
Fax: 610-489-6645

 

Perigon Pharmacy 360

1120 Stevenson Mill Road #200  
Coraopolis, PA 15108
Phone: 412-684-2500
Fax: 844-582-5332

 

Premier Pharmacy Services

1049-51 Broadway #2  
Bethlehem, PA 18015
Phone: 800-540-4700
Fax: 800-540-3400

 

Rochester Health Mart Pharmacy

176 Virginia Ave.
Rochester, PA 15074
Phone: 724-987-6085
Fax: 724-987-6084

Soleo Health, Inc.

950 Calcon Hook Road
Suite 19 
Sharon Hill, PA 19079
Phone: 610-200-6502 | 866-737-1919
Fax: 610-726-1882

 

SunRay Drugs Specialty

142 S. 52nd Street  
Suite 201  
Philadelphia, PA 19139
Phone: 888-260-9555
Fax: 215-471-4001

 

Value Specialty Pharmacy

1333 Plank Road  
Suite 200  
Duncansville, PA 16635
Phone: 855-265-8008
Fax: 844-812-6227

Prior Authorizations for Specialty Medications

  • Fax all requests for new prior authorizations or renewals to our pharmacy department at 1-866-240-3712. For questions, please contact our pharmacy department hotline at 215-991-4300.
  • Please select a specialty pharmacy and list the preference on the fax.
Health Partners (Medicaid), CHIP and Jefferson Health Plans IFP Formulary Updates
Frequently Asked Questions

We offer 90-day prescriptions for inexpensive, chronic medications for all members. However, we encourage 100-day prescriptions for Medicare members who have chronic conditions. Our members usually can save time and money with extended day prescriptions, which can impact compliance with their medication regimen. Special pricing is available through network pharmacies and our mail order program. Note: extended day supplies are not available for specialty drugs.

A drug recall list can be found on the FDA's website. Any members affected will receive a drug recall from Jefferson Health Plans.

Please submit these requests in writing to the pharmacy department. Requests for additions to the formulary will be reviewed by the P&T Committee.