Sometimes, our members need access to drugs that are not covered by their plan. One way to access non-covered drugs is by using cash pay. Select Health, through our Rx Savings Solutions option, now has coupons such as GoodRx available inside your member account. You can use these coupons to get lower cost for some drugs when you pay cash instead of using your insurance benefits. Additionally, Select Health will review non-covered medications through our exception review process. If this is your situation, we highly recommend that you ask your prescribing doctor to submit the request by completing the electronic form on our pharmacy preauthorization portal.
Prescription costs can vary widely based on the type of drug and whether it's a brand-name or generic. To find out how much a prescription will cost, log in to your member account and and use the Drug Lookup Tool.
Note: Prescription pricing is based on quantity. You may receive the greatest savings when you fill a prescription for a 90-day supply, when available. Cost may also vary depending on the pharmacy.
Prescription drug coverage varies by plan. To learn more about which drugs are covered by your plan (also referred to as a formulary), refer to your prescription drug list. If you have questions regarding drug coverage, please call us at 800-538-5038.
Our goal is to keep treatments accessible and affordable for our members. Sometimes, that means we have to remove coverage for high-cost medications while keeping coverage for lower cost medications that are proven effective. Other times, we may have to increase the amount our members pay for a certain drug, if the cost of the drug rises. Adjusting our pharmacy coverage allows us to keep premiums as low as possible while still giving members access to effective medications.
Like many other products and services (such as gasoline or milk), prescription costs may change over time. Prices can vary depending on the medication, dosage, and market demand. You can log in to your member account to search for drugs, their prices, and find lower cost alternatives.
There could be several reasons why your drug was not covered. Log in to your member account to see if the drug your doctor plans to prescribe is covered by your plan. If you use a smart phone you may know if the drug is covered prior to leaving your doctor's office. That way you can have a discussion with your doctor about alternatives, if needed.
If you have questions about coverage, please call us at 800-538-5038 so we can help you understand your benefits or determine why a drug was not covered. To view your paid pharmacy claims, log in to your member account.
On most plans, you have two options for filling prescriptions: Visit a participating pharmacy or get your prescription through Intermountain Home Delivery. Many doctors will e-prescribe your prescription directly to the participating pharmacy (certain medications cannot be e-prescribed) of your choice. If your doctor gives you a paper prescription, take it to a participating pharmacy or call the Intermountain Home Delivery pharmacy.
A generic drug is made by a competing drug company after the original maker’s patent has expired. The U.S. Food and Drug Administration requires generics to have the same dosage, safety, strength, and quality as the original brand-name medication, but generics are almost always less expensive than brand-name drugs. Using generic drugs may save you money.
A formulary, or prescription drug list, is a list of the drugs covered by your health insurance plan. Log into your online member account to view a searchable list.
If a drug requires step therapy, your doctor must first prescribe alternative options that are generally more cost effective. (It typically applies to brand-name drugs.) A medication may be covered without step therapy if determined to be medically necessary. Your doctor can request an exception.
Quantity limits apply to certain drugs for which you can only fill a limited number of tablets or capsules per prescription. Preauthorization is required if the quantity of the prescribed drug exceeds plan limits.