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Your Pharmacy Benefits at A Glance

Before you fill a prescription, it can be helpful to review the basics about how your pharmacy coverage works.

As a new SelectHealth member—or even if you’ve been with us a while—you might need some help figuring out your pharmacy benefits. We’ve can help you understand how your pharmacy coverage works.

How do I know if a medication is covered?

The best way to find out if a drug is covered is by logging into My Health. Once logged in, click the SelectHealth icon and then choose “Rx Claims.” From there, you can use our drug lookup tool to find out if a drug is covered.

You can also look at your SelectHealth ID card—it will tell you what prescription drug list is covered by your plan. Visit our Pharmacy Benefits page and select your drug list to find the most commonly covered medications.

If you still have questions, call Member Services to speak with someone on our Pharmacy team. They can help you understand if a specific drug is covered by your plan.

How do I know what my prescription copay will be?

All medications fall in to one of four (or five) tiers, depending on your plan. Each tier corresponds to a specific copay or coinsurance amount—this is the amount you pay.

  • Preferred generic and generic drugs – lowest cost
  • Nonpreferred generic drugs
  • Preferred brand name drugs – higher cost
  • Nonpreferred brand name drugs – highest cost
  • Specialty oral and injectable drugs

Medications that fall in to lower tiers may provide the treatment you need at the best value.

How can I find a pharmacy or compare drug prices?

Log in to My Health as described above, and you’ll be able to:

  • Search for a participating pharmacy near you
  • See what drugs are covered using your prescription drug list
  • View claims: When you fill a prescription, you can view the drug name, date(s) filled, and the total cost of the drug

What is step therapy and preauthorization?

For some medications, we require step therapy or preauthorization before they will be covered. If your medication requires step therapy, your doctor must first prescribe a more cost-effective medication (i.e., trying a generic drug before the name-brand). In some cases, step therapy and preauthorization may be waived for medical necessity. Keep in mind that just because a medication is more cost-effective, it doesn’t mean that clinical quality is compromised.

Still have questions? Member Services can help. Call us at 800-538-5038.

And while you’re here, check out our other healthy living articles. 

 

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The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not be used to diagnose or treat a health problem or disease. Please consult your healthcare provider if you have any questions or concerns.

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