![]() Large Group Tier 3 HMO and PPO Prescription Drug List DMHC Version ().Large Group Tier 3 PPO Prescription Drug List CDI Version ( cycle).Large Group Tier 3 PPO Prescription Drug List CDI Version ().Standard Tier 4 HMO and PPO Prescription Drug List DMHC Version ( cycle).Standard Tier 4 HMO and PPO Prescription Drug List DMHC Version ().Standard Tier 4 PPO Prescription Drug List CDI Version ( cycle).Standard Tier 4 PPO Prescription Drug List CDI Version ().Search for your Tier 4 drugs on the Formulary Viewer. Search for your Tier 3 drugs on the Formulary Viewer. If you need an exclusion exception, view our process as described in Your Right to Request an Exclusion Exception. The following Prescription Drug Lists for California may be refreshed on a monthly basis. Essential Tier 4 Prescription Drug List for UnitedHealthcare, All Savers, Golden Rule, Neighborhood Health Plan and River Valley medical plans ().Traditional Tier 4 Prescription Drug List for UnitedHealthcare and Student Resources medical plans ().Traditional Tier 3 Prescription Drug List for UnitedHealthcare, River Valley, Oxford and Student Resources medical plans (). ![]()
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