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