Get Individual and Family plan prescription information
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 prescription drugs with our online search
Use the interactive Marketplace formulary to look up your medications. The list of covered drugs under your plan is called a "formulary." Our team of 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 of 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. As 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.
Save money by using generics
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
- Healthcare 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
Self-help tools
Self-help tools include web access and tools to provide drug pricing transparency, alternative drugs, history of drug claims and side effect information
Mail order pharmacies
Security Health Plan partners with Optum Rx as its pharmacy benefit manager (PBM). Security Health Plan members can get 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 prescriptions service for no charge. Learn more about how you can set up mail order prescriptions at www.marshfieldclinic.org/Services/pharmacy.
Using the Optum Home Delivery mail order pharmacy is completely voluntary. Members may continue to obtain their medication from any affiliated pharmacy.
Resources
2027
Marketplace Formulary (online search tool)
2027 Marketplace Comprehensive Formulary
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
2026
Marketplace Formulary (online search tool)
2026 Marketplace Comprehensive Formulary
2026 Choice Diabetic List
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