 |
The Texas A&M University System |
Pharmacy
The Scott & White Health Plan uses a formulary (a list of drugs) that has been selected by a committee of Scott & White Physicians and Pharmacists. These medications are selected based on research that shows their safety and effectiveness. Since there can be many different brands of similar prescription medicines, the formulary is used to select the medication that proves to be most effective in treating an illness.
| Authorization Requirements - A one-time prescription which costs the amount specified or more and refillable prescriptions whose total cost is the amount specified to the right will require preauthorization by the SWHP Medical Director. | A one-time prescription of $175 Total cost of $1200 |
| Quantity Limitations | Initial or refill prescription: up to a 34 day supply. Maintenance: up to a 90 day supply. |
| Deductible | $50 |
| Copayments - Retail (up to a 34-day supply) | |
| Generic | $5 |
| Preferred | $25 |
| Non-preferred and alternate choice drugs (subject to out-of-pocket maximum) |
$50 or 50% of charges, whichever is less |
| Drugs not on Health Plan Formularies | $50 or 50% of charges, whichever is more |
| Copayments - Maintenance (up to a 90 day supply) (You must purchase a 34-day supply on new prescriptions for first six months of use.) | |
| Generic | $10 |
| Preferred | $50 |
| Non-preferred and alternate choice drugs | $100 or 50% of charges, whichever is less |
| Drugs not on Health Plan Formularies | N/A |
| Maximum Benefit | Unlimited |
| If a brand name drug is dispensed when a generic is available, 50% copay applies. | |
Bookmark this Page
Print this Page
Resize Text
