---
type: CKG Bundle
title: Payer Formulary
tags: [Healthcare & Life Sci]
timestamp: 2026-06-18T00:00:00Z
ckg:
  id: payer-formulary
  nodes: 75
  license: CC BY 4.0
---

# Payer Formulary — Compressed Knowledge Graph

```csv
ConceptID,ConceptLabel,TaxonomyID
1,Healthcare Payer,FOUND
2,Commercial Payer,PAYER_TYPE
3,Medicare Advantage Plan,PAYER_TYPE
4,Medicaid Managed Care Organization,PAYER_TYPE
5,Pharmacy Benefit Manager,PAYER_TYPE
6,United Healthcare,PAYER_EXAMPLE
7,Cigna,PAYER_EXAMPLE
8,Aetna,PAYER_EXAMPLE
9,Anthem,PAYER_EXAMPLE
10,CVS Caremark,PBM_EXAMPLE
11,Express Scripts,PBM_EXAMPLE
12,OptumRx,PBM_EXAMPLE
13,Formulary,FOUND
14,Formulary Tier,FOUND
15,Tier 1 Generic,TIER
16,Tier 2 Preferred Brand,TIER
17,Tier 3 Non-Preferred Brand,TIER
18,Tier 4 Specialty,TIER
19,Tier 5 Specialty Non-Preferred,TIER
20,Coverage Criteria,FOUND
21,Prior Authorization,COVERAGE_CRITERIA
22,Step Therapy,COVERAGE_CRITERIA
23,Quantity Limits,COVERAGE_CRITERIA
24,Medical Exception Process,COVERAGE_CRITERIA
25,Utilization Management,UTILIZATION_MGMT
26,Drug Class,FOUND
27,GLP-1 Receptor Agonist,DRUG_CLASS
28,SGLT-2 Inhibitor,DRUG_CLASS
29,DPP-4 Inhibitor,DRUG_CLASS
30,Insulin Analogue,DRUG_CLASS
31,Semaglutide,DRUG
32,Tirzepatide,DRUG
33,Dulaglutide,DRUG
34,Liraglutide,DRUG
35,Exenatide,DRUG
36,Wegovy,BRANDED_DRUG
37,Ozempic,BRANDED_DRUG
38,Mounjaro,BRANDED_DRUG
39,Zepbound,BRANDED_DRUG
40,Victoza,BRANDED_DRUG
41,Obesity Indication,INDICATION
42,Type 2 Diabetes Indication,INDICATION
43,Cardiovascular Risk Reduction,INDICATION
44,BMI Threshold Criterion,COVERAGE_CRITERIA
45,Comorbidity Requirement,COVERAGE_CRITERIA
46,Diet Program Requirement,COVERAGE_CRITERIA
47,Prescriber Specialty Requirement,COVERAGE_CRITERIA
48,Formulary Exception,COVERAGE_CRITERIA
49,Non-Formulary Drug,FORMULARY_STATUS
50,Formulary Preferred Drug,FORMULARY_STATUS
51,Specialty Drug Criteria,TIER
52,Commercial Formulary,FORMULARY_TYPE
53,Medicare Part D Formulary,FORMULARY_TYPE
54,Medicaid Preferred Drug List,FORMULARY_TYPE
55,Coverage Determination,PROCESS
56,Appeal Process,PROCESS
57,Peer-to-Peer Review,PROCESS
58,Electronic Prior Authorization,PROCESS
59,Real-Time Benefit Tool,TECHNOLOGY
60,Formulary Lookup,TECHNOLOGY
61,PBM Contract,CONTRACT
62,Rebate Agreement,CONTRACT
63,Net Drug Cost,ECONOMICS
64,Patient Out-of-Pocket Cost,ECONOMICS
65,Copay,ECONOMICS
66,Coinsurance,ECONOMICS
67,Deductible,ECONOMICS
68,Out-of-Pocket Maximum,ECONOMICS
69,Manufacturer Copay Card,ECONOMICS
70,Coverage Gap Donut Hole,MEDICARE_PART_D
71,Low Income Subsidy,MEDICARE_PART_D
72,Formulary Change Notification,COMPLIANCE
73,Annual Formulary Review,PROCESS
74,Specialty Pharmacy Requirement,COVERAGE_CRITERIA
75,Home Delivery Requirement,COVERAGE_CRITERIA
```

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