Avera Health Plans is pleased to offer a variety of pharmacy benefit options to members and employers. Below, you will find a range of useful resources available to you.
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).
- Avera Health Plans Abbreviated 3-Tier Drug Formulary (pdf)
- Avera Health Plans Abbreviated 6-Tier Drug Formulary (pdf)
Medication Search Tool
Depending our your health plan, we provide different search tools. Here are two examples of search look-up tools for our members:
- Medication Search for 3-Tier Plans
- Medication Search for 4-Tier Plans
- Medication Search for 6-Tier Plans
Not all injectable medications are covered on the pharmacy benefit. The injectable medication must be considered self-injectable which means you are able to give yourself the medication safely without risk. If the injectable medication is not considered self-injectable, the medication may be covered under the medical benefit. The following list indicates what injectable medications are covered on the pharmacy benefit:
Medications Requiring Prior Authorization
Some medications will require prior authorization. Please review the following lists to determine if a medication requires prior authorization:
- Medical: Medical Medications Requiring Prior Authorization (pdf)
- Pharmacy: Pharmacy Medications Requiring Prior Authorization (pdf)
Specialty medications treat chronic, complex conditions such as hepatitis C, multiple sclerosis,
cancer and rheumatoid arthritis. These medications tend to be higher in costs and require special storage and handling. Avera Health Plans has a network of specialty pharmacies available to assist you with specialty medication needs. The current list of medications that are considered specialty can be found here:
Step therapy is intended to use the most cost-effective and safest medication available for a specific medical condition. Step therapy programs require your provider to prescribe Step One medication before Step Two medication. For a list of Step Therapy Programs, see the list below:
- Step Therapy Programs (pdf)
If you want more information about the process, please review our Step Therapy Process (pdf).
Note: The above information is provided to you as a general reference. Not all plans or members will use these pharmacy programs. These references are not a guarantee of coverage.
Benefit determinations are based on the member’s contractual agreement. Exclusions, limitations or exceptions may apply. Benefits vary based on contract, and individual member benefits must be verified.
Please use our Pharmacy Locator tool to find a participating pharmacy near you.