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SCAN Drug Formulary Guide

Category: Formulary

SCAN Health Plan Comprehensive Formulary

A formulary is a list of covered drugs selected by SCAN Health Plan. We generally cover drugs listed in our formulary as long as it is medically necessary, the prescription is filled at a SCAN network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage (EOC) document available on the Plan Materials page.

SCAN covers both brand name drugs and generic drugs. A generic drug has the same active ingredient(s) as the brand name drug but generally costs less.

The Medicare program allows SCAN to make changes in our formulary at any time during the calendar year. A change in our formulary can change which drugs are covered, the members’ copay and limit on usage.

 

How do I request an exception to the SCAN Health Plan Formulary?

You can ask SCAN 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 approve exception requests when alternative drugs included on the plan’s formulary, or additional utilization restrictions would not be as effective in treating the member’s condition and or would cause 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.

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:

Email: memberservices@scanhealthplan.com
Phone: 1-800-559-3500 (TTY User: 711) 8:00 a.m. – 8:00 p.m. PST – Monday – Friday, 9:00 a.m. – 4:00 p.m. – Saturday. Messages received on holidays and outside of our business hours will be returned within 1 business day.

Requesting an exception to the SCAN Health Plan’s Formulary

This formulary services the counties covered under the SCAN service area. For a complete listing of covered areas, click here.

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