Formulary Resources
CenterLight's Clinical Pharmacy Management staff is responsible for the development and management of the PACE formulary, a list of medications that are covered under this plan.
Additionally, we provide a comprehensive medication regimen review for eligible participants and serve as a source of drug information to not only our patients, but to all healthcare professionals on the Interdisciplinary Care Team.
Please click on the following links to access information regarding our Clinical Pharmacy Programs. You may also contact our Pharmacy Benefit Manager (PBM) at:
MedImpact Help Desk for DUAL: 1-844-336-2681
MedImpact Help Desk for MEDICAID ONLY: 1-888-678-7779
Formulary Resources
Please click on the links below to access Formulary Resources in pdf format.
Formulary
Please note: Diabetic supplies and Continuous Glucose Monitoring (CGM) are limited to Abbott meters, test strips, reader (1 per year) and sensors (2 sensors per 28 days) such as FreeStyle Freedom Lite, FreeStyle Lite, Precision Xtra, FreeStyle Libre, and FreeStyle Libre 2.
- Drug Coverage Determination Form (English, Spanish coming soon) (PDF 25KB)
- Drug Coverage Determination Form (Online)
2024 Materials
- 2024 Formulary (English) (PDF, 4.9MB) (Last updated October 2024)
- 2024 Formulary (Spanish) (PDF, 1.6MB) (Last updated October 2024)
- 2024 Pharmacy Directory/Directoria de Farmacias (English and Spanish) (PDF, 3.2MB) (Last updated October 2024)
- Pharmacy Directory (Online)
- 2024 Prior Authorization Criteria (English) (PDF, 1.1MB) (Last updated October 2024)
- 2024 Step Therapy Criteria (English) (PDF, 121KB) (Last updated October 2024)
2025 Materials
- 2025 Formulary (English) (PDF, 1.9MB) (Last updated October 2024)
- 2025 Formulary (Spanish) (PDF, 5.5MB) (Last updated October 2024)
- 2025 Pharmacy Directory/Directoria de Farmacias (English and Spanish) (PDF, 2.3MB) (Last updated October 2024)
- 2025 Prior Authorization Criteria (English) (PDF, 1.1MB) (Last updated October 2024)
- 2025 Step Therapy Criteria (English) (PDF, 237KB) (Last updated October 2024)