Pharmacy Benefits

As an Avera Health Plans member, you receive pharmacy benefits to help make your prescriptions more affordable and convenient. To find out what your specific pharmacy benefits are and what medications or services require a preauthorization, log in to the member portal.

The following content is provided as a general reference of our pharmacy benefits. Not all plans or members will use the same pharmacy programs.

Prescription Coverage for Members

As an Avera Health Plans member, the amount you pay for a prescription depends on the drug's tier level and the benefit level associated with your plan, which is shown on your Summary of Benefits and Coverage. Log in to the member portal to view your Summary of Benefits and Coverage and learn more about your specific plan benefits.

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

Many individual plans and small employer plans have a 6-tier formulary plan:

6-Tier Drug Formulary

6-Tier Drug Formulary

Tips to Maximize your Pharmacy Benefits

To make the most of your pharmacy benefits, we recommend that you:

  • Choose a participating pharmacy. Find a pharmacy with Avera Health Plans' pharmacy benefit manager CVS/Caremark.
  • Pay the pharmacy your co-pay or co-insurance 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.
  • Use generic drugs whenever possible.

You can also choose to receive your prescriptions by mail order. Fill out and submit this Avera Mail Order Request Form to get started.

Reviewed by LM on November 01, 2019