Note Title
Eligible At No Cost
Definition
For certain plans, this oral chemotherapy medication is available through the pharmacy benefit at no cost ($0) to members.
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Medication Lookup
The results below have been sorted using a 2-tier plan. For the most accurate search results, check your plan details and choose another tier plan from the drop-down menu near the search bar.
BRAFTOVI (Eligible for $0 copay)
THERAPEUTIC CLASS: ANTINEOPLASTICS*
Select a strength to see details
75MG CAPS
75MG CAPS
Covered by a 3-Tier Plan as a Tier 2 Medication
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us in order to be covered through the pharmacy benefit.
50MG CAPS
50MG CAPS
Covered by a 3-Tier Plan as a Tier 2 Medication
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Note TitleEligible At No CostDefinitionFor certain plans, this oral chemotherapy medication is available through the pharmacy benefit at no cost ($0) to members.
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Note TitlePrior Authorization RequiredDefinitionThis medication requires your doctor to obtain prior authorization from us in order to be covered through the pharmacy benefit.
Prior Authorization Forms
Massachusetts Standard Form for Hepatitis-C Medication Prior Authorization Requests
Massachusetts Standard Form for Medication Prior Authorization Requests
Massachusetts Standard Form for Synagis® Medication Prior Authorization Requests
Important Information
Affordable Care Act (ACA) Medication List
Medical Benefit Prior Authorization Medication List
Over-the-Counter Exclusion Medication List
Quality Care Dosing Guidelines
Learn About Your Pharmacy Program
Learn About Your Pharmacy Program
Affordable Care Act (ACA) Medication List
Cost-Share Assistance Program Medication List
Health Savings Account (HSA) Preventive Medication List
Lower-Cost, Brand-Name Insulins Medication List
Medical Benefit Prior Authorization Medication List
No-Cost Generic Medications List
Over-the-Counter Exclusion Medication List
Specialty Pharmacy
Specialty Pharmacy Medication List
5-Tier Specialty Pharmacy Medication List
6-Tier Specialty Pharmacy Medication List
Alternatives to Opioids
For Federal Employee Program Members
Eligible Medicare Members
Covered Alternative Medications