Vivid Clear Rx Performance Formulary

The Vivid Clear Rx Performance Formulary is a list of drugs covered under your pharmacy benefit and developed to serve as a guide for physicians, pharmacists, healthcare professionals and members. This formulary is continually reviewed. Should you have any questions, please call us at (877) 848-4379.

Search for drug coverage below or view more details in our Vivid Clear Rx Performance Formulary

Drug NameSpecialtyTierPA RequiredQuantity Limit
A-Methapred SOLUTION RECONSTITUTED 125 MG InjectionNo1NoNo
A-Methapred SOLUTION RECONSTITUTED 00 MG InjectionNo1NoNo
AK-Poly-Bac Ointment 500-10000 UNIT/GM OphthalmicNo1NoNo
AVC Vaginal Cream 15 % VaginalNo3NoNo
Acacia PowderNo3NoNo
Accupril Tablet 10 MG OralNo3NoNo
Accupril Tablet 20 MG OralNo3NoNo
Accupril Tablet 00 MG OralNo3NoNo
Accupril Tablet 5 MG OralNo3NoNo
Acetaminophen POWDERNo3NoNo