The EnvisionRx Pharmacy and Therapeutics Committee is responsible for the development and maintenance of
the EnvisionRx Formulary. The Committee is comprised of independent, practicing physicians and pharmacists from a wide
variety of medical specialties. The EnvisionRx Formulary is reviewed and updated from time to time as new drugs or new
prescribing information becomes available. Factors which affect decisions regarding the EnvisionRx Formulary include safe
use, clinical efficacy, and therapeutic need. Cost factors are considered only after a review of safe use, clinical efficacy
and therapeutic need. Decisions are reached by a committee’s simple majority vote. Committee members remain free from
conflict of interest, or abstain from voting on particular issues for which they have a conflict of interest. Compliance
with the EnvisionRx Formulary is important for improving quality of care and restraining health care costs.
Your benefit plan features either the Preferred Drug List or Performance Formulary.
Refer to your plan-specific documents or contact your plan administrator for further information.