Contact Lens Formulary
| TYPE | LENS | MANUFACTURER |
|---|---|---|
| Daily Wear Includes two lenses |
Visitint | CIBA |
| Planned Replacement Includes two boxes |
Purevision (Silicon Hydrogel) Proclear Compatibles Frequency 38 Frequency 55 |
Bausch & Lomb® Cooper / OSI Cooper / OSI Cooper / OSI |
| Disposable Includes four boxes |
Soflens 38 (6 pack) Focus Dailies (30 Pack) Encore Premium O2 Optix Cooper Clear FW Biomedics XC (Silicon Hydrogel) Biomedics 38 Biomedics 55 Clear Site (1-Day 30 pack) Freshlook LT Acuvue Acuvue 2 Acuvue Advance 1-Day Acuvue |
Bausch & Lomb® CIBA Vision® CIBA Vision® CIBA Vision® Cooper / OSI Cooper / OSI Cooper / OSI Cooper / OSI Cooper / OSI Cooper / OSI Johnson & Johnson Johnson & Johnson Johnson & Johnson Johnson & Johnson |
Formulary is subject to change without notice. All contact lenses on the Formulary are Single-Vision Spherical lenses. Participating providers will determine if the lenses prescribed are on the formulary.
