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Provider Manual

Drug Formulary

Last Updated on January 24, 2019

The drug formulary is a list of drugs covered by Security Health Plan for members with a drug benefit. The formulary shows the tier level a drug is assigned to and which drugs require prior authorization or those that have other pharmaceutical management restrictions. The scope of the formulary is limited to those drugs safely self-administered by the member in the ambulatory setting. Typically new molecular entities are not added to the formulary for the first six months they are commercially available to allow time for review. Pharmaceutical evaluation and formulary management is an integrated process, which enables physicians, pharmacists and other health care professionals to work together to promote clinically-sound, cost-effective pharmaceutical care.

Medications are assigned to tiers based on usage, cost and clinical effectiveness. Plans vary in design with two, three or four tiers, and each tier has a different copayment or coinsurance level depending on the plan design. Our prescription drug search can show you which tier applies to a specific medication based on the members benefits.

Family Health Center contracts with Security Health Plan to provide administrative functions for Family Health Center members.