2014 SCAN Drug Formulary Guide
What is the SCAN Health Plan Comprehensive Formulary?
A formulary is a list of covered drugs selected by SCAN Health Plan in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. SCAN Health Plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a SCAN Health Plan’s network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.
SCAN Health Plan covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs.
The Medicare program allows us to make changes in our prescription drug formulary list at any time during the calendar year. As previously explained, the formulary is a list of drugs. A change in our drug formulary could affect which drugs are covered, the members co pay and the limit on usage.
How do I request an exception to the SCAN Health Plan’s Formulary?
You can ask SCAN Health Plan to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make.
Generally, SCAN Health Plan will only approve your request for an exception if the alternative drugs included on the plan’s formulary, or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects.
You should contact us to ask us for an initial coverage decision for a formulary, or utilization restriction exception. When you request a formulary, or utilization restriction exception, you should submit a statement from your prescriber or physician supporting your request. Generally, we must make our decision within 72 hours of getting your prescriber’s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we get a supporting statement from your doctor or other prescriber.
For more information contact Member Services. California Members call 1-800-559-3500, 7:00 a.m. - 8:00 p.m., 7 days a week. TTY users should call 711, Arizona Members:1-888-540-7226, 8:00 a.m. – 8:00 p.m, 7 days a week TTY users should call 711, 8:00 a.m. – 8:00 p.m, 7 days a week.
This formulary services the counties covered under the SCAN service area. For a complete listing of covered areas, click here.
To download the SCAN 2014 formulary introduction in
, click here.
To download the SCAN 2014 drug formulary for
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How to use the On-line Formulary Search Tool
1) You can search by Drug Name
2) You can search by Therapeutic Category
3) You can view SCAN Formulary Drugs in Alphabetical Order:
Simply click on the letter below to find a complete listing of all medications in the SCAN Drug Formulary beginning with that letter.
How to request an exception to the SCAN Health Plan’s Formulary? For more information click here.
Transition Policy Statement
To view the SCAN 2014 transition policy in
, click here.