Scott & White Health Plan

Pharmacy Services-Prior Auth/Formularies

• Prescription Drug Benefit Summary
   
• Overview of Scott & White Health Plan Formulary
   
• Formularies
  • Scott & White Health Plan
    • Alphabetical
    • Therapeutic Category
    • Specialty Formulary
    • Formulary Changes
  • Hillcrest Preferred Drug List - Please be advised that the formulary for the Hillcrest Employee Medical Plan may have changed for 2011. It is not the same as the standard SWHP formulary.
  • Metroplex Preferred Drug List
  • Medicare Part D Formulary
    • SeniorCare Rx (Value Rx, Basic Rx, Enhanced Rx): 4 Tier Formulary
       
• Formulary Addition Request Form/Instructions
   
• Prior Authorization Forms/Formulary Exception Request Form
  • Scott & White HMO
    • Byetta® (exenatide)
    • Orencia® (abatacept)
    • Pradaxa (dabigatran)
    • Synagis 2011-2012
    • Other drugs
    • Prior Authorizations/Formulary Exception Request (electronic)
  • Medicare Part D
    • Medicare Part D Coverage Determination Request
    • Medicare Part D Redetermination Request Medicare Part B
    • Hyaluronic acids (e.g. Synvisc®, Supartz®, etc.)
    • Reclast® (zoledronic acid