Get small employer prescription information
Let us help you learn more about your prescription drugs. You can look up your prescription drugs and learn how much you will pay for them. Or locate a network pharmacy near you.
Employers with a SimplyOne, Enrich, Reliance or Premier plan may reference the Marketplace Formulary. The Commercial Formulary is for those members who are on the Freedom (Indemnity) plan. Please reference your ID card to find your plan name.
How are prescription drugs covered
Save on your prescriptions
We understand prescriptions can be expensive. That’s why we offer more ways you can save.
Activate an Rx Savings Solutions account and you will see cost-saving opportunities for your prescription drugs that are personalized to you and your Security Health Plan coverage.
Find your drugs with our online search
Use the interactive drug list above to look up the medications you take. The list of covered drugs under your plan is called a "formulary". Our team of on-staff physicians and pharmacists reviews information on new and existing drugs and regularly updates the formulary with drugs that are safe and effective. Our interactive formulary is updated by the fifth business day each month.
Drug tiers explained
- Tier 1: Lower-cost generic medications – drugs covered at the lowest out-of-pocket costs.
- Tier 2: Mid-range cost preferred brand-name – can help reduce your out-of-pocket costs when used instead of a Tier 3 drug.
- Tier 3: Higher cost non-preferred – many Tier 3 drugs have a lower cost option in Tier 1 or Tier 2. Ask your provider if a lower tiered option would work for you.
- Tier 4: Generic/preferred biosimilar specialty medications – these typically require additional information from you or your provider to determine coverage. Lower cost options may be available.
- Preventive Benefit: Preventive drugs, $0 cost sharing. Medication not subject to deductible.
Importance of generics
In most cases, you will save money by using generic drugs when they are available. If you receive the brand name or reference drug for a medication when a generic equivalent or biosimilar is available, you must pay the applicable copayment or coinsurance plus an ancillary charge. The ancillary charge is the cost difference between the brand name or reference drug and the generic equivalent or biosimilar alternative. The ancillary charge will not count toward your out-of-pocket limit for prescriptions.
How to request an “exception” for your prescription drug.
Sometimes a drug you have been prescribed is not on our formulary. You may request a formulary exception (also called a medical exception) to receive coverage for a non-formulary prescription drug or medical supply. Learn more about the prescription drug coverage exception process and how to initiate a pharmacy exception.
To initiate an exception process, send an email request to: shppharmacyum-mfld@Sanfordhealth.org. The request should include:
- Member's name
- Health care provider’s name, address and telephone number
- Prescription drug strength, dosage form and directions
- Diagnosis
- Lab medical data
- The medical reason for the request
Medication therapy management
Talk with a pharmacist who can help you find ways to:
- Minimize or eliminate medication side effects
- Reduce the number of drugs you take
- Find lower-cost alternatives
Opioid management
Opioids relieve moderate to severe pain but can have side effects and serious risks. Safety measures help reduce opioid use.
Self-help tools
My Security Health Plan provides you tools for drug pricing transparency, alternative drug choices, drug claims history and side effect information
Mail order pharmacies
Security Health Plan will partner with Optum Rx as its pharmacy benefit manager (PBM), effective Jan. 1, 2026. At that time, members of Security Health Plan have the option of getting their prescriptions through the mail using Optum Home Delivery Pharmacy. The program includes Optum as your mail order pharmacy for home delivery of covered medications and supplies or for discounts on other prescriptions. For more information, visit www.optumrx.com. Residents of Wisconsin may also use the Marshfield Clinic mail-order prescription services at no charge. Learn more about how you can set up mail order prescriptions at www.marshfieldclinic.org/Services/pharmacy.
Using Optum is completely voluntary. Members may continue to obtain their medication from any affiliated pharmacy.
Resources
2027
2027 Marketplace Formulary (online search tool)
Prescription Drug List updates for 2027 Exchange plans
2026
2026 Marketplace Formulary (online search tool)
2026 Marketplace Comprehensive Formulary
2026 Choice Diabetic List
Other
Optum home delivery order form
Optum home delivery order form (Spanish)
Prescription drug reimbursement form
Prescription drug reimbursement form (PDF)
List of medications that require step therapy
List of medications that require prior authorization
Drug Safety News
New rules for pain medications