6-Tier Drug Formulary Search

A drug formulary is a list of prescription drugs under a benefit plan, which are approved for use for specific treatments and dispensed through participating pharmacies to members. The drug formulary changes periodically. Your plan covers both brand and generic drugs. Generic drugs have the same active ingredient as the brand name drug.

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).

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

• Go back to your secured login page, My Pharmacy
• Click on the link to request a drug formulary exception
• Complete the online form and submit
• Determination will be made no later than 24 hours (after the request is received) for urgent requests and 72 hours for standard requests

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

There are multiple reasons and it is important to call our Customer Care Center toll-free at 1-888-322-2115, Monday - Friday, 8 a.m. - 5 p.m. CT so we can look into your records and provide an explanation for the pharmacy declining the request. Or email Service@AveraHealthPlans.com, provide a phone number to be reached and someone will contact you.