Is My Drug Covered?

Our List of Medications, also known as a Formulary, is a list of Part D medications covered by your Select Health Medicare plan. You can determine what formulary to look at based on the Select Health Medicare plan on which you are enrolled.

2025 Formularies

Essential Formulary

If you are enrolled on any Select Health Medicare plan except Select Health Medicare Enhanced or Select Health Medicare No Rx, your drugs are covered on the Essential Formulary.

2025 Essential Formulary

IdahoColoradoColorado HMO-DSNP

NevadaUtahUtah HMO-DSNP

picture_as_pdf  2025 Essential Formulary

picture_as_pdf  2025 Essential Completo Formulario de Medicamentos Cubiertos

picture_as_pdf  2025 Essential Formulary Step Therapy Criteria

picture_as_pdf  2025 Essential Formulary Prior Authorization Criteria

Enhanced Formulary

If you are enrolled on Select Health Medicare Enhanced (HMO) 007, the Enhanced Formulary is your formulary.

2025 Enhanced Formulary

Utah

picture_as_pdf  2025 Enhanced Formulary

picture_as_pdf  2025 Enhanced Completo Formulario de Medicamentos Cubiertos

picture_as_pdf  2025 Enhanced Formulary Step Therapy Criteria

picture_as_pdf  2025 Enhanced Formulary Prior Authorization Criteria

How Much Will My Drug Cost?

See how much you will pay for a covered drug. Log in to your Select Health account 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.

You can visit our Part D Stages page to understand which stage of coverage you are in and how that will affect your cost.

How Can I Get My Drug Covered?

There may be drugs that aren’t on your formulary or that have special requirements, such as prior authorization or step therapy, that you need to meet before they are covered. If you aren't sure why a drug isn't covered, our Pharmacy team can help. Call 855-442-9900 (TTY: 711).

Drug Exceptions and Prior Authorization

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 855-442-9988 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.

Drugs with Special Requirements

Some drugs have special requirements that must be met before Select Health 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.

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

Quantity Limits are designed to limit the use of selected medications for quality, safety, or utilization reasons. Limits may be on the amount of the medication that we cover per prescription or for a defined period of time.

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 prior authorization process or the drug exception process.

Use the links below to see drugs with special requirements on your formulary (the drugs covered by your plan).

SPECIAL REQUIREMENTS

Essential Formulary Special Requirements

picture_as_pdf  2025 Step Therapy Criteria

picture_as_pdf  2025 Prior Authorization Criteria

Enhanced Formulary Special Requirements

picture_as_pdf  2025 Step Therapy Criteria

picture_as_pdf  2025 Prior Authorization Criteria

Part B Step Therapy

Some Part B covered drugs require your provider to first prescribe alternative options that are generally more cost effective without compromising quality, including:

Notice of Formulary Updates

Generally, if you are taking a medication on our formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the medication during the coverage year. If there is new information that the medication is not safe or effective, we will remove it from our formulary.

If we remove medications from our formulary, or add prior authorization, quantity limits, and/or step therapy restrictions on a medication, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the medication, at which time the member will receive a 60-day supply of the medication.

To view any changes, please review the Negative Formulary Change documents:

picture_as_pdf  Negative Formulary Change (2-01-2025)

picture_as_pdf  Negative Formulary Change (3-01-2025)

Can I Get a Temporary Supply?

Under certain circumstances, the plan can offer a temporary supply of a drug to you when your drug is not on the Drug List or when it is restricted in some way. Doing this gives you time to talk with your provider about the change in coverage and figure out what to do.

To be eligible for a temporary supply, you must meet the two requirements below:

The change to your drug coverage must be one of the following types of changes:

• The drug you have been taking is no longer on our formulary.
• The drug you have been taking is now restricted in some way
  
  

You must also be in one of the situations described below: 

• You are asking for a temporary supply during the first 90 days you are a member of our plan
  We will cover a temporary 30-day supply. If your prescription is written for fewer days, we’ll allow refill to provide up to a maximum 30-day supply of medication. After your first 30-day supply, we will not pay for these medications, even if you have been a member of the plan less than 90 days.
  
  
• You are a resident of a long-term care facility
  If you are past the first 90 days of membership in our plan, and a resident of a long-term care facility, we will cover a 31-day emergency supply of that medication while you pursue a formulary exception.
  
  
• You are experiencing a change in your level of care 
  If you experience a change in your level of care, such as a move from a hospital to a home setting, we will cover a one-time, temporary supply for up to 30 days (or 31 days if you are a long-term care resident) when you use a network pharmacy. During this period, you should use the plan's exception process if you wish to have continued coverage of the medication after the temporary supply is finished.

Pharmacy Networks

Access your prescription drug benefits conveniently through a network of more than 55,000 pharmacy locations nationwide. Most of our partner pharmacies are national chains, so you are covered while traveling.

100-Day Prescriptions

Pick up a 100-day supply of your maintenance medications at participating pharmacies or by mail order through Intermountain Home Delivery. This program offers both convenience and cost savings. Sign up for Intermountain Home Delivery.