Tier 3 Prescription Drugs

Search for medications on Avera Health Plans 3-Tier Formulary, which include both brand and generic drugs. Generic drugs have the same active ingredient as the brand-name drug.

What is a drug formulary?

What is a drug formulary?

The drug formulary lists include both generic and brand-name medications approved by the U.S. Food & Drug Administration (FDA). It includes covered prescription drugs approved for use for specific treatments and dispensed through participating pharmacies. Avera Health Plans works with a team of health care providers to choose drugs that provide quality treatment. We cover drugs on the drug formulary that are:

  • Medically necessary
  • Approved by the FDA
  • Filled at a participating pharmacy

Current Members

If you already have health insurance with Avera Health Plans, log in to access details on your pharmacy benefits – and to determine if certain medications or services require a preauthorization.

Log in

Pharmacy Coverage

More member FAQs

3-Tier Drug Formulary Search

Not a Member Yet? Check out this list of commonly covered drugs (the formulary) from the selections below.

Important: Drug formularies change periodically. Only use this list to identify whether a prescription is an approved drug in the 3-Tier benefit plan.


Drug Formulary Search

Member Pharmacy Questions

We have answers on questions members frequently ask about pharmacy benefits. Learn more about pharmacy coverage in our member resources.

How much will I pay for prescriptions?

How much will I pay for prescriptions?

The amount you pay for your prescription depends on the drug's tier level and the benefit level shown on your Summary of Benefits and Coverage (see page 3).

How do I request an exception to the drug formulary?

How do I request an exception to the drug formulary?

You can ask Avera Health Plans for an exception to the benefit coverage rules. To request a drug formulary exception:

  1. Go back to your secured login page, My Pharmacy.
  2. Click the link to request a drug formulary exception.
  3. Complete the online form and submit.

For urgent requests, determination will be made no more than 24 hours after the request is received. For standard request, determination takes 72 hours.

Generally, we will only approve the exception request if you’ve tried alternative drugs available on the drug formulary and they haven’t been effective for treating your condition and/or would cause adverse side effects to you if you were to try them.

Why did the pharmacy decline my prescription request?

Why did the pharmacy decline my prescription request?

There are multiple reasons why a prescription may be declined. If you have questions, contact us so we can look into your records and provide an explanation for the pharmacy declining the request.

More Information

Need More Help?

Shop Plans

Ready to get great coverage and start saving? Check out plans for yourself, your family or your business.

Shop Now

Member Resources

Have a question or looking to pay your premium? Go to our member resources for answers, benefit information and much more.

Get Help

Our Website Uses Cookies

This website uses cookies to give you the very best experience. Your continued use of this site is considered permission by you to use cookies in this manner. Please review our Privacy Commitment and Notice for terms of use, the types of cookies we use and more information about the data we collect. Please note, if you navigate from our website to a third-party site of any kind, that website has its own terms and conditions.