Pharmacy Benefits

As an Avera Health Plans member, you'll receive a variety of pharmacy benefit options, including immunizations.

To get the most out of your pharmacy benefits and prevent illness, we recommend that you periodically review your immunization record with your health care provider.

Most of the time, insurance will cover all, if not a majority of the cost. Prevention is well worth the cost. Stay healthy. Check out the list of preventive services and get your shots!

Recommended Immunizations

Children Adults

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).

New individual plans and small employer plans will have a 6-tier drug formulary plan:

Other resources:


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.

To find out more about what your specific plan covers for pharmacy benefits and what medications or services require a preauthorization, log in to our online portal.


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.
  • Show your member ID card at the pharmacy each time you fill a prescription.
  • 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.