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Prescription Drug Benefits

The Scott and White Health Plan uses a formulary (a list of drugs) that has been selected by a committee of Scott and 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.

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

Preventive Care Medications

Under the Affordable Care Act, also known as the health care reform law, SWHP covers some preventive care medications at 100% without charging a copay, coinsurance or deductible. The following list of drugs and products require a prescription (including over-the-counter medications) and filled at a network pharmacy to be covered at no cost share.

Drug Tier Definitions for Individual and Family Plans

Benefit Descriptions