Formulary Documents

The SCAN Formulary is a list of prescription drugs covered by your plan.

To review or download your plan Formulary, please choose from the list below.

To search for a prescription drug in the Formulary, please use our Find a Formulary Drug search tool by clicking here.

If you’d like a printed copy of the Formulary mailed to your home, please click here and fill out the Formulary request form.

NOTE: If you choose to have your Formulary mailed to your home, all future Formularies will also be mailed to your home until you request otherwise by contacting Member Services.

Prior Authorization Forms

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