Is My Drug Covered?

To see the drugs covered by your plan:

Log in to My Health

If you get health insurance through your employer, your drug list is either RxCore or RxSelect. The name of your prescription drug list is shown in My Health under SelectHealth and Rx Claims, and it's also listed on your ID card.

RxCore®

If you purchased individual health coverage for yourself or your family (including through healthcare.gov or yourhealthidaho.org), RxCore is your formulary.

RxCore PDL (Utah)

      Lookup Online

      Download PDF

RxCore PDL (Idaho)   

      Lookup Online

      Download PDF

RxSelect®

There are two versions of RxSelect: one with four tiers of coverage and one with three tiers. If you aren't sure which tier applies to your plan, call us at 800-538-5038.

RxSelect 4 Tier PDL (Utah)

      Lookup Online

      Download PDF

RxSelect 4 Tier PDL (Idaho)

      Lookup Online

      Download PDF

RxSelect 3 Tier PDL

      Lookup Online

      Download PDF

SelectHealth Community Care® (Medicaid)

      Community Care Prescription Drug Lookup

      The Preferred Drug List

 

How Much Will My Drug Cost?

See how much you will pay for a covered drug. Log in to My Health, click on SelectHealth, and then Rx Claims.

You can also see an estimate of how much a drug will cost with the Drug Lookup tool, but keep in mind that your benefits may differ from what is shown.

 

How Can I Get My Drug Covered?

There may be drugs that aren’t on your prescription drug list or that have special requirements, such as preauthorization or step therapy, you need to meet before they are covered. If you aren't sure why a drug wasn't covered, our Pharmacy team can help. Call 800-538-5038.

Drugs with Special Requirements

Some drugs have special requirements that must be met before SelectHealth will cover them.

Step Therapy drugs require your provider to first prescribe alternative options that are generally more cost effective without compromising quality. Step therapy may be waived if determined to be medically necessary.

Preauthorization is required for certain drugs. This process must be completed by your doctor before you fill your prescription.

Use the links below to see drugs with special requirements on your formulary (the drugs covered by your plan). The name of your formulary is included on your ID card.

      RxSelect Special Requirements

      RxCore Special Requirements

      Medicare Special Requirements

      Medicaid Special Requirements

If your physician believes that you require a medication that is not on your formulary, normally requires step therapy, or exceeds a quantity limit, he or she may request an exception through the preauthorization process or the drug exception process.

Drug Exceptions

If you need a prescription for a medication that is normally not covered under your plan, you may ask for an exception to your plan’s prescription drug coverage. Obtaining an exception decision takes between 24 (emergent) and 72 hours (standard) . Many requests can be handled over the phone by calling 800-538-5038, or by filling out the Exception Request Form. Some requests may need to be submitted by your physician. If the exception is denied, you have the right to appeal that decision as with any other denial.

Pharmacy Networks

Access your prescription drug benefits conveniently through a network of more than 45,000 pharmacy locations nationwide, with 400 locations in Utah and Idaho. Most of our partner pharmacies are national chains, so you are covered while traveling.

90-Day Prescriptions

Pick up a 90-day supply of your maintenance medications at participating Retail90 pharmacies or by mail order through Intermountain Home Delivery. This program offers both convenience and cost savings. Register for Intermountain Home Delivery.