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Pharmacy Information

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Prescription Drug Benefits for Plan Year 2017

The Scott & White Health Plan uses a formulary (a list of drugs) that has been selected by a committee of Scott & White Physicians and Pharmacists. These medications are selected based on research that shows their safety and effectiveness. Since there can be many different brands of similar prescription medicines, the formulary is used to select the medication that proves to be most effective in treating an illness.

Members have access to our Pharmacy Benefits Manager allowing them to see pharmacy claim information, find eligible pharmacy locations, find prescription deductible information, drug information and drug pricing.

Baylor Scott & White Health Plan Pharmacy Locations

Drug Tier Definitions for Individual and Family Plans 


Tier 1 (Preferred Generic Medications)

  • Generic drugs
  • Lowest cost option

Tier 2 (Preferred Brand Medications)

  • Preferred brand-name products based on safety, efficacy, and cost
  • Second lowest cost option

Tier 3 (Non-Preferred Brand and Generic Medications)

  • Brand name and generic drugs for which alternatives are available in Tier 1 or Tier 2
  • Not used typically as a first-line of treatment
  • Higher copayment or coinsurance option

 

Benefits Descriptions


Benefits Description Member Pays 
Plan Year Deductible $50 per person per plan year

If a brand-name medication is dispensed when a generic is available, member will be responsible for the generic copay plus the cost difference between the generic and the brand-name medication.

Participating Retail Pharmacy- Tier 1 /Tier 2 / Tier 3

Up to 30-day supply per prescription or refill of Non-Maintenance medication $10/$35/$60
Up to 30-day supply per prescription or refill of Non-Maintenance medication $10/$45/$75
Infertility drugs 50%
Up to a 30-day supply of insulin for one copay $10/$35/$60
Up to a 30-day supply of each diabetic oral agent for one copay $10/$35/$60
The supply of necessary disposable syringes for the insulin supply for one mail order copay  $125/day
Diabetic supplies other than insulin, diabetic oral agent(s) and syringes as specified in Section 1358.051(2), Tex Ins. Code up to a 90-day supply 20%

Mail Order Pharmacy- Tier 1 /Tier 2 / Tier 3

Up to a 90-day supply per prescription or refill for one mail order copay. In addition to using mail order, you may also obtain a 90-day supply of approved medication at any of the Baylor Scott & White Health Plan Pharmacies $30/$105/$180
Infertility drugs 50%
Up to a 90-day supply insulin for one mail order copay $30/$105/$180
Up to a 90-day supply of each diabetic oral agent for one mail order copay
$30/$105/$180
The supply of necessary disposable syringes for the insulin supply for one mail order copay  $105
Diabetic supplies other than insulin, diabetic oral agent(s) and syringes as specified in Section 1358.051(2), Tex. Ins. Code up to a 90-day supply. 20%