Erickson Advantage Formulary
To see the list of drugs covered under Erickson Advantage you may access the PDFs below or visit the Optum Rx formulary website.
For the Champion Plan:
English PDF | Spanish PDF | Optum Rx Online Formulary Website
For the Guardian Plan:
English PDF | Spanish PDF | Optum Rx Online Formulary Website
For the Liberty with Drugs, Freedom, and Signature Plans:
English PDF | Spanish PDF | Optum Rx Online Formulary Website
Erickson Advantage Drug Management
Click the links below to download your necessary documents.
- 2022 Pharmacy Directory (external link - opens in 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)
- Part D Model Coverage Determination Request Form (PDF opens in a new window)
- Part D Model Coverage Redetermination Request Form (PDF opens in a new window)
- Medication Prior Authorization Request Form (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 (external link - 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.