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 drugs 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.

Preauthorization for Pharmacy Benefits

If you want to find out more about what drugs will require a preauthorization, step therapy or acceptable self-injectables, visit This will also provide you information how the preauthorization process works with your health plan.

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. A new list of preventive pharmacy drugs that are available at no cost.

Reviewed by LS on March 05, 2018

Pharmacy Benefits for Individual Plans

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

If you are shopping for an individual plan, 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.


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

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