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.
Get a copy of the Formulary or look up a medication online.
A copy of our Formulary along with recent changes can be downloaded at the links below. Or, if you prefer, we will mail you a copy of the most recent version. Just contact our Member Services department by email or phone:
Call Member Services at 1-800-559-3500 for additional information. (TTY Users: 711). Hours are 8 a.m. to 8 p.m., seven days a week from October 1 to February 14.
From February 15 to September 30 hours are 8 a.m. to 8 p.m. Monday through Friday. Messages received on holidays and outside of our business hours will be returned within one business day.
This formulary services the counties covered under the SCAN service area. For a complete listing of covered areas, click here. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
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.
- You can ask us to cover a drug even if it is not on our formulary. If approved, this drug will be covered at a pre-determined cost-sharing level, and you would not be able to ask us to provide the drug at a lower cost-sharing level.
- You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, SCAN Health Plan limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover a greater amount.
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.
How to request an exception to SCAN Health Plan’s Formulary? For more information click here.
The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.