Standard PA Request


Drug Formulary
Download the abbreviated 4-page formulary in PDF format.

Disclaimer: Not all medications are listed in this formulary reference. If you have any questions, please contact Pharmacy Services. Physicians Plus reserves the right to change the formulary at any time without notice. Oral Contraceptives - Detailed Formulary Listing

Generic Sampling Program
Members can receive their first one month supply of select generic prescriptions at no charge with the Generic Sampling Program. Remember to prescribe from this list of generic drugs to help members take advantage of this program.

GO-TO Rx Manager
Get the most from your prescription drug coverage when you make informed choices.

GO-TO Rx Manager allows personal review of prescription drug history, the Physicians Plus drug formulary and drug cost comparisons. It’s especially useful for helping you choose lower-cost drugs or those with lower copays.

You must have or sign up for a GO-TO account to use GO-TO Rx Manager.

Maintenance Drug List
Members may obtain select medications, including contraceptives at a three months supply (90 days) for three copays with a prescription from their health care provider.

Tablet Splitting Program
Members can save up to 50% on out-of-pocket costs for some of their medications using the Physicians Plus Tablet Splitting Program.

Download and print the one-page instruction sheet showing your patient how to use a tablet splitter.