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Tier 6 Prescription Drug Benefit

Brand-name drugs like Eliquis, Xarelto, Entresto, Januvia, Tradjenta, Jardiance, and Farxiga are affordable with SCAN Medicare Advantage Plans.

Tier 6: Select Care Drugs for the Treatment of Diabetes and Heart Disease

SCAN knows the important role medications play in keeping our members healthy and independent. Our goal is that it's always easy for our members to get their medications, and this includes making them affordable—which is why we’ve added Tier 6, a new tier to SCAN’s Formulary (or list of covered drugs). Tier 6 makes 13 brand-name prescription drugs more affordable for SCAN members; depending on the SCAN plan, members will pay either $0 or $11 for a 30-day supply of a Tier 6 drug* beginning January 1, 2024.

Big Savings for Popular Brand-Name Drugs

There are six cost-sharing “tiers” for drugs on SCAN’s Formulary, and every drug on the Formulary is in one of the six tiers. In general, the higher the tier, the higher the cost for the drug—except for Tier 6. SCAN’s Tier 6 allows you to actually pay less for popular, brand-name prescription drugs. The medications on Tier 6 are commonly prescribed medications for conditions like high blood pressure, diabetes, and rheumatoid arthritis.

Some of the most-popular medications covered in SCAN’s Tier 6 include:

  • Eliquis and Xarelto: blood thinners used to treat and prevent blood clots to lower the risk of stroke.
  • Entresto: used for those with chronic heart failure.
  • Jardiance and Farxiga: used to treat type 2 diabetes, chronic kidney disease, and can reduce the risk of heart failure and cardiovascular disease.
  • Januvia and Tradjenta: used to lower blood sugar levels in people with type 2 diabetes.
  • And these six combination drugs:

    • Glyxambi
    • Janumet
    • Jentadueto
    • Synjardy
    • Trijardy
    • Xigduo

SCAN Medicare Advantage Makes Prescription Drugs Affordable

Currently, 90% of medications taken by SCAN members are available for $0. Dual-eligible members enrolled in SCAN Connections (HMO SNP) and SCAN Strive (HMO SNP) pay $0 for all medications covered on our drug list. And depending on the SCAN plan, insulin pens and vials, Humalog, Humulin, Lantus, Levemir, Lyumjev, Soliqua, Toujeo, and Tresiba are covered on SCAN’s Formulary list for either $0 or $25 per month, including the coverage gap, at SCAN preferred pharmacies. **

Use SCAN’s Formulary search tool to look up the medications you take. If your medication is listed, make note of what tier it’s on, and then check your SCAN plan benefits list for your copayment amounts for each tier. For most SCAN plans, SCAN Preferred pharmacies offer lower copays on many medications.

And, if you don’t have a Medicare Advantage plan, take a look at the many benefits, award-winning service, and extensive network of caring doctors, offered by SCAN.

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SCAN plans and benefits vary by county. Please tell us your zip code so we can show you the plans available in your area.

Frequently Asked Questions about SCAN Tier 6

Where can I check to see if my medications are covered on Tier 6?

Use our SCAN Formulary to see if your medications are covered under Tier 6. Or call SCAN Member Services at (800) 559-3500 TTY: 711 from 8 a.m. to 8 p.m., seven days a week from October 1 to March 31. From April 1 to September 30, hours are 8 a.m. to 8 p.m. Monday through Friday.

Is the Tier 6 copay amount different depending on if I use a SCAN Preferred or Standard pharmacy?

You’ll pay the same $0 or $11 per month Tier 6 copay at any of SCAN network pharmacies.*

I’m already taking one of these medications now. Will I have to do anything different to get the new, lower copay starting in January 2024?

You won’t have to do anything different to get your Tier 6 medications for no or low copays. The new pricing will be reflected at SCAN’s network of pharmacies when they process your Tier 6 medications with your SCAN ID card.

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