Formulary (List of Covered Drugs)
A formulary is a list of drugs covered by our health plan. South Country Health Alliance will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a South Country Health Alliance network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage (under Member Materials to the right).
Formulary medications are FDA-approved and have been chosen for their reported medical effectiveness and value. The formulary is updated at times throughout the year, and the list of drugs may change. The law does not allow certain drugs to be covered through Medicare Part D. When a drug is not covered under Medicare Part D, in many cases it may be covered by Medical Assistance.
Click here to search our online formulary. For a printable version of our formulary, view the List of Covered Drugs under Member Materials to the right.
What if my drug is not in the formulary?
First, contact Member Services and ask if your drug is covered. If Member Services tells you that South Country Health Alliance does not cover your drug, you have two options:
- Your doctor or pharmacy can call the PerformRx Provider Help Desk to discuss options that are covered by South Country Health Alliance. The Provider Help Desk number is on the back of your ID card.
- You can ask South Country Health Alliance to make an exception and cover your drug. For more information on how to request an exception, go to our Part D Coverage Determination, Appeals, and Exceptions page.
This information is not a complete description of benefits. Contact the plan for more information.
South Country Health Alliance covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
Coverage of prescription drugs and supplies listed on the drug list/formulary is subject to your benefit plan’s design and coverage provisions and may differ from that listed. Not all generic drugs are equivalent to the available brand drug. Please check with your pharmacist.
Benefits, premiums and/or copayments may change on January 1 of each year.
Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances. Limitations, copayments, and restrictions may apply.
Copays may vary based on the level of Extra Help that beneficiaries may receive. Contact your plan for further details.
More Information for AbilityCare
|AbilityCare Member Materials|
|Evidence of Coverage||2019 PDF||2020 PDF|
|Annual Notice of Changes||2019 PDF||2020 PDF|
|Summary of Benefits||2019 PDF||2020 PDF|
|Pre-Enrollment Checklist||2019 PDF||2020 PDF|
|List of Covered Drugs (Formulary)||2019 PDF||2020 PDF|
|Formulary Updates||November 2019||N/A|
|Provider and Pharmacy Directory||Web Page|
|Medicare Star Ratings||2019 PDF||2020 PDF|
|LIS Premium Summary Chart||2019 PDF||2020 PDF|
|CMS Best Available Evidence Coverage||Web Page|
|Covered Diabetic Testing Supplies||2019 PDF||2020 PDF|