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Provider Manual

Drug Formulary

Last Updated on August 28, 2018

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. Pharmceutical 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.

Medication Tier

Types of medications

Cost sharing

1

Most generics

Lowest cost share

2

Preferred brands/select generics

Middle cost share

3

Non-preferred brands/select generics

Higher cost share

4

Specialty medications and some very high cost brand/generic medications

Highest cost share

*Certain medications are not covered and are considered non-formulary (NF). A member may request a medical exception for a non-formulary prescription medication or medical supply. The exception request may be initiated by the member, or a provider acting on behalf of the member, in writing or by verbal request. For a copy of the formulary exception policy or to start a formulary exception request please contact the Pharmacy Services Department at  1-877-873-5611.

If your plan only has 3 medication tiers, all tier 4 medications will have the same cost share as tier 3.

Interactive Formulary

Use our interactive formulary to view a list of drugs covered for Security Health Plan members. An interactive formulary allows you to view the most current tier placement, pharmaceutical management restrictions (such as prior authorization, step therapy or quantity limits), specialty pharmacy requirements and any additional coverage details. The interactive formularies are updated monthly and are available online.

For your convenience Security Health Plan maintains separate formularies. Navigate to www.securityhealth.org/prescriptiontools    to find  the interactive formulary for each product line.

Please call Security Health Plan Pharmacy Services Department at 1-877-873-5611 ext. 1-9604 or 715-221-9604 for additional information.