Pharmacy Services
Prescription Drug Benefit for 2013
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.
| PRESCRIPTIONS | Tier One S&W Owned pharmacies |
Tier Two SWHP national pharmacy network |
Tier Three Non network |
| Annual benefit maximum | None | ||
| Ask a SWHP Pharmacy representative how to save money on your prescriptions. | Retail Quantity Up to 34-day supply Mainentenance Quantity up to a 90-day supply. (Maintenance fills are available at Tier 1 pharmacies or mail order) |
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| S&W Pharmacies | Retail Pharmacies | Out of Network | |
| Preferred Generic | $3/$6* | $6 | Not covered |
| Oral Contraceptives (generic)** | $0 | $0 | |
| Preferred Brand | $35/$70* | $50 | |
| Non-preferred | Lesser of $50/$100* or 50% | Lesser of $75 or 50% | |
| Non-formulary | 50% | 50% | |
| Mail Order | 800-707-3477 | ||
| Online Refills | swhp.org | ||
| NOTATIONS | |||
| Any claim incurred through a non network provider could result in balance billing and/or additional charges to the member. | |||
| Prior authorization required for certain services. Failure to secure "prior authorization" for services listed on the SWHP website will result in no coverage/benefit paid under the Plan. | |||
| Copays and balance billing do not apply to the annual out of pocket maximum. | |||
| Pharmacy copays and coinsurance do not apply to the annual out of pocket maximum. | |||
| * Mandatory Generic Provision: If you chose to receive a brand name drug when a generic drug is available, your costs will be equal to the brand copay (or Coinsurance) plus the difference in cost between the generic and brand-name drug. | |||
| **Brand name contraceptives may also be covered at no charge if the member is already on a brand name drug or goes through step therapy. | |||
| The above is intended to provide a summary of Plan benefits. Please refer to the Summary Plan Description for a full list of covered services and provisions. | |||
Log into Argus* for access to:
- Pharmacy claim information
- Eligible pharmacy location information
- Pharmacy deductible information
- Drug information
- common side effects and risks
- drug-drug interactions
- availability of generics
- Drug pricing
*This function is not available for SeniorCare or the Medicare Part D membership.