2024 Pharmacy Benefits Archive

FSA LPFSA Reimbursement Claim Form
Prior Authorizations and Appeals Program
Advanced Control Specialty Formulary
Performance Drug List – Standard Control for Clients with Advanced Control Specialty Formulary
Medicare Part D Formulary (Feb. 2024)
Pelican HRA1000 Pharmacy Benefits
Magnolia Local Plus Pharmacy Benefits
Magnolia Open Access Pharmacy Benefits
Magnolia Local Pharmacy Benefits
Silverscript Benefits for Medicare Retirees

2023 Pharmacy Benefits Archive

FSA LPFSA Reimbursement Claim Form
OGB Recurring Expense Form DCAP1
Summit Debit Reimbursement Substantiation Claim Form
2022 Flexible Benefits Plan Summary
DCAP Reimbursement Claim Form
Flexible Spending Arrangement Enroll Stop Form
Advanced Control Specialty Formulary
Performance Drug List-Standard Control for Clients with Advanced Control Specialty Formulary