Pharmacy Benefits

When you enroll with Avera Health Plans, you'll receive a variety of pharmacy benefit options. 

IMPORTANT:  Members, if you want to find out what your specific plan covers for pharmacy benefits and what medications or services require a preauthorization, log in to see your pharmacy benefits. This page is for applicants to see what a new plan may offer.  

Stay healthy.

Check out the list of preventive services to identify what a new plan will cover if applying for individual health insurance. Most of the time, insurance will cover all, if not a majority of the cost for preventive services. 

Prescriptions and Pharmacies

Our Drug Formulary is a list of prescription medications that contains both generic and brand-name medications that have been approved by the U.S. Food and Drug Administration (FDA).

If you are shopping for a new individual plans and small employer plans, you will have a 6-tier drug formulary plan:

Other resources:

NOTE: The information provided is a general reference of our pharmacy benefits. Not all plans or members will use the same pharmacy programs.

As a member, call our Service Center toll-free at 1-888-322-2115 if you have specific questions around your prescription, pharmacy claims or the pharmacy preauthorization approval process.

Preauthorization for Pharmacy Benefits

Benefits vary based on plan design and individual benefits. Benefit determinations are based on the member’s plan selection. Exclusions, limitations or exceptions may apply.

IMPORTANT: Members, if you want to find out more about what your specific plan covers for pharmacy benefits and what medications or services require a preauthorization, please log in.

Tips

To maximize your pharmacy benefits, we also recommend the following:

  • Use generic medications whenever possible.
  • Choose a pharmacy that participates with the Avera Health Plans pharmacy benefit manager. (Members, login to identify who your pharmacy benefit manager is. Links will be provided after you login.)
  • Pay the pharmacy your co-pay for the prescription. If the retail cost is less than the co-pay, you’ll pay the retail amount for the medication.
  • Show your member ID card at the pharmacy each time you fill a prescription.