Dean Health Plan (DHP) has a PDF document that lists all the formulary medications and their corresponding tier level. The document is long, but you can search it easily by clicking the binocular icon on your toolbar. You can search the online list of DHP formulary drugs at www.deancare.com. Once there, click on “Dean Health Plan,” then “For Members,” then “Pharmacy Information,” and finally “Drug Formulary.”

The Pharmacy Information website has two additional lists that may be viewed online: the Drug Prior-Authorization List, which includes Drugs Restricted to Certain Specialists, and the Drug Exclusion List. You can also call Customer Service at 608-828-1301 or 800-279- 1301 for a complete copy of either list or for more information about your prescription drug benefit.

Drug Prior-Authorization List
The medications on this list require prior authorization (PA) by Dean Health Plan. Brand names are listed first, with the generic name in parentheses.

Added to PA List
Byetta (exenatide)
Revatio (sildenafil)

Removed From PA List
Focalin (dexmethylphenidate)

As drugs are approved by the U.S. Food and Drug Administration (FDA), we may add them to this list. Your physician or pharmacist should fill out a Drug Prior-Authorization Request Form. For urgent authorizations, your physician should call Customer Service.

Drug Exclusion List
Our drug benefit does not automatically cover every new drug that the FDA approves. We have a panel of physicians from many different specialties to evaluate new drugs. If an excluded drug has been prescribed for you, ask your physician or pharmacist if he or she can substitute it with one of the medications that we cover. Brand names are listed first, with the generic name in parentheses.

Recently Excluded
BENICAR HCT*
Cozaar (losartan)*
Hyzaar (losartan HCT)
Lunesta (eszopiclone)
MIRCETTE**
Opcon-A (naphazoline/antazoline)*
OVCON*
Symlin (pramlintide)**

Removed From Excluded List and Now Covered in Tier 2
Atacand (candesartan)
Avalide (irbesartan HCT)
Avapro (irbesartan)

General exclusions: Nonprescription over-the-counter drugs, weight-loss products, drugs for cosmetic use and oral medications for the treatment of sexual dysfunction

Please note: Some members may have coverage for one of these drugs based on an exception in their pharmacy benefit or an authorization from Dean Health Plan.

*Not covered under the two-tier pharmacy benefit; covered under the three-tier pharmacy benefit

**Not covered under all pharmacy benefit programs

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