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H3664 CY2025aAPP INDIVIDUAL ENROLLMENT FORM
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FORMUARY DRUGS WITH RESTRICTIONS AND CRITERIA content
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Electronic Funds Transfer EFT Form
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Evidence of Coverage
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Provider Directory
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Pharmacy Directory
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Fillable Form H3664 23 PTHP Appeal Request
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1.1.2025 5T Individual Abridged Formulary 25390
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1.1.2025 5T Individual Comprehensive Formulary 25390
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2025 Formularies
PrimeTime Health Plan formulary covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as…
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