Is My Drug Covered?
To see the drugs covered by your plan:
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 PDL (Utah)
RxCore PDL (Idaho)
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)
RxSelect 4 Tier PDL (Idaho)
RxSelect 3 Tier PDL
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.
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.
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.
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.
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.
All Individual plans include our RxCore formulary (Utah) (Idaho). A formulary is a list of covered prescription drugs. In an effort to help keep your costs as low as possible, RxCore excludes more expensive brand-name drugs when there is a lower-cost generic option or over-the-counter equivalent available. A generic drug is a medication with the same active ingredients, safety, dosage, quality, and strength as its brand-name counterpart. Providers and pharmacists agree that generic medications are as safe and effective as brand-name drugs.
Individual plan RxCore pharmacy benefits have four tiers (levels) of coverage. Each tier includes different drugs and copays/coinsurance. Tier 1 medications are available at the lowest cost. On some plans, the pharmacy deductible does not apply to these drugs.
Certain medications are not covered. If you have questions before applying for coverage or using your pharmacy benefits, call Member Services or visit the Pharmacy section of our website. You may also search our list of covered medications online or call to request a copy.