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Silver Trio HMO

Department of Managed Health Care (DMHC) plans

Individual & Family Plan drug formulary links

Grandfathered Individual & Family Plan drug formulary links

Small group drug formulary links

Large group Plus drug formulary links

Large group Plus drug formulary links for grandfathered plans

Large group Value drug formulary links

Large group Performance drug formulary links

Standard drug formulary

Search Standard drug formulary by drug name

Standard drug formulary (PDF, 2.3 MB)


Coverage-related drug lists

Specialty drugs English (PDF, 220 KB) | Spanish (PDF, 218 KB)

Preventive drug list (ACA) English (PDF, 44 KB) | Spanish (PDF, 70 KB)

Contraceptive drugs English (PDF, 104 KB) | Spanish (PDF, 105 KB)

HDHP Preventive drugs English (PDF, 77 KB) | Spanish (PDF, 79 KB)

Vaccines English (PDF, 77 KB) | Spanish (PDF, 75 KB)

Plus drug formulary

Search Plus drug formulary by drug name

Plus drug formulary (PDF, 3.4 MB)


Coverage-related drug lists

Specialty drugs English (PDF, 221 KB) | Spanish (PDF, 197 KB)

Preventive drugs (ACA) English (PDF, 44 KB) | Spanish (PDF, 71 KB)

Contraceptive drugs English (PDF, 104 KB) | Spanish (PDF, 105 KB)

HDHP Preventive drugs English (PDF, 78 KB) | Spanish (PDF, 101 KB)

Vaccines English (PDF, 82 KB) | Spanish (PDF, 75 KB)

Value-Based tier drugs English (PDF, 95 KB) | Spanish (PDF, 94 KB)

Plus drug formulary

Search Plus drug formulary by drug name

Plus drug formulary (PDF, 3.4 MB)


Coverage-related drug lists

Specialty drugs English (PDF, 190 KB) | Spanish (PDF, 197 KB)

Value drug formulary

Search Value drug formulary by drug name

Value drug formulary (PDF, 2.3 MB)


Coverage-related drug lists

Specialty drugs English (PDF, 209 KB) | Spanish (PDF, 218 KB)

Preventive drugs (ACA) English (PDF, 44 KB) | Spanish (PDF, 71 KB)

Contraceptive drugs English (PDF, 104 KB) | Spanish (PDF, 105 KB)

HDHP Preventive drugs English (PDF, 77 KB) | Spanish (PDF, 79 KB)

Performance drug formulary

Search Performance drug formulary by drug name

Performance drug formulary (PDF, 2.3 MB)


Coverage-related drug lists

Specialty drugs English (PDF, 158 KB) | Spanish (PDF, 195 KB)

Preventive drugs (ACA) English (PDF, 44 KB) | Spanish (PDF, 71 KB)

Contraceptive drugs English (PDF, 104 KB) | Spanish (PDF, 105 KB)

HDHP Preventive drugs English (PDF, 77 KB) | Spanish (PDF 78 KB) 

Vaccines English (PDF, 82 KB) | Spanish (PDF, 75 KB)

Value-Based tier drugs English (PDF, 91 KB) | Spanish (PDF, 94 KB)