Members with a closed Formulary 2 Tier prescription benefit are limited to use of Formulary agents only A therapeutic trial of samples of a NonFormulary or Prior Authorization agent will not be accepted as appropriate Please be sure to list all therapies that have been previously tried on the request form so that your request can be processed in a timely manner What they Do and How they are Used p Common Prescription Drugs Known to Cause Insomnia Antihypertensives Sympathomimetics Hormones p Anticholinergics p CNS Stimulants Miscellaneous Naturally Occurring p Ration
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