SelectHealth | Total Fitness | Winter 2016

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The following section outlines information
for members who have SelectHealth
pharmacy benefits.
For more information or to request a
hard copy of a prescription drug list,
call Member Services at 800-538-5038
or visit . You can also
log in to My Health to access useful
pharmacy tools.
PARTICIPATING PHARMACIES
To get the most from your pharmacy
benefits, use a participating pharmacy
and present your ID Card when you fill
a prescription.
PRESCRIPTION DRUG LIST
SelectHealth plans that offer drug
coverage use a tiered Prescription
Drug List of brand-name and generic
drugs. An expert panel of doctors and
pharmacists (called the Pharmacy and
Therapeutics Committee) selects drugs
for this list based on safety, quality, and
cost-effectiveness. The list may change
periodically because of new drugs, new
therapies, or other factors. The main
difference between the tiers is the amount
you pay. Using Tier 1 drugs, for example,
will cost you less.
GENERIC DRUGS
You can save money by using generic
drugs. Generic drugs contain the same
active ingredients as their brand-name
counterparts. The U.S. Food and Drug
Administration (FDA) regulates generic
drugs just like brand-name drugs.
A generic drug will usually be substituted,
unless a doctor states on the prescription
that the brand-name drug must be used
for medical reasons. Some plans require
that generic drugs be used and do not
cover brand-name drugs when generics are
available. If you or your doctor requests
a brand-name drug when a generic is
available, you will often pay a higher
copay/coinsurance plus the difference in
cost between the generic drug and brand-
name drug. In some cases, you will need
to pay for the drug in full.
90-DAY PRESCRIPTION BENEFIT
Some plans offer a 90-day prescription
benefit for those drugs you use regularly.
These are referred to as maintenance
drugs. This benefit allows you to
get maintenance drugs conveniently
and often at a lower cost through a
participating neighborhood pharmacy or
by mail delivery.
For mail order, use the Intermountain
Home Delivery Pharmacy by enrolling at
. For retail pick-
up service, use a participating Retail90®
pharmacy. You are eligible for Retail90 if
you have already filled your prescription
once at any retail pharmacy or through
an eligible home delivery pharmacy
in the past six months using your
SelectHealth benefit.
Call Member Services or check the
Prescription Drug List to find out if your
medication is eligible for the 90-day
prescription benefit. Member Services can
also tell you what retail pharmacies are
participating on your plan.
DRUGS WITH SPECIAL
REQUIREMENTS
(STEP THERAPY AND
PREAUTHORIZATION)
Certain drugs must meet special
requirements before they are covered. If
a drug requires preauthorization, your
provider must call us before you purchase
your medication. Prescription drugs
that require preauthorization are listed
on our website and identified on your
Prescription Drug List.
If a drug requires step therapy, your
doctor must first prescribe an alternative
drug. These are generally more cost-
effective and do not compromise clinical
quality. If your doctor feels that an
alternative drug will not meet your needs,
he or she can request an exception. These
drugs are also listed on our website and
identified on your Prescription Drug List.
SPECIALTY MEDICATIONS
Specialty medications are usually covered
by your pharmacy benefits. In rare cases,
some members may also have coverage
for specialty medications through their
medical benefits. These types of drugs may
be administered orally, as a single injection,
through an intravenous infusion, or
through an inhaler or nebulizer. Generally
used to treat an ongoing chronic illness,
they can be given by a medical professional
or through self-administration.
The Intermountain Specialty Pharmacy
can deliver specialty medications to
your home at no additional cost. Call
844-442-4600 to start service with the
Intermountain Specialty Pharmacy.
EXCLUDED DRUGS
Not all prescription drugs are covered. Call
us or visit to learn more.
Note: Some employers may choose a company
other than SelectHealth to administer
pharmacy benefits. For more information,
please refer to your member materials.
Know your
pharmacy benefits
Total Fitness | Winter 2016 |
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