skip to main content

Text/HTML

Pharmacy Information

Text/HTML

Here’s a quick summary of the prescription drug benefits for you and your family.

If you are eligible for a Medicare Part D prescription drug plan, please read this Important Notice from TRS-ActiveCare About Your Prescription Drug Coverage and Medicare.

* $100 annual prescription deductible does not apply to generic drugs.

CO-PAYMENT

Retail

Maintenance

Formulary List A (generic drugs) $3 $6
Formulary List B (brand-name drugs — please see Benefit Limitations) 30% after deductible 30% after deductible
Formulary List C (alternate choice brand-name drugs) 50% after deductible 50% after deductible
Non-Formulary drugs Greater of $50 or 50% after deductible N/A
Benefit Maximum: unlimited Greater of $50 or 50% after deductible  

Benefit Limitations

The Scott & White Health Plan will only cover the cost of the generic medications when they are available. If a brand-name drug is dispensed when there is a generic available, the enrollee will pay a 50% co-payment.

Exclusions

This drug benefit does not provide coverage for over-the-counter (OTC) medications and selected prescription drugs and therapeutic devices. Please refer to the prescription drug benefit rider included with your Scott & White Health Plan Group Health Care Agreement for further details on the exclusions to this benefit. Common examples include but are not limited to drugs used primarily for cosmetic purposes; drugs used primarily for the treatment of infertility, contraceptive devices or implants; and drugs used primarily for weight loss.

Quantity Limitations (Unless otherwise specified on the SWHP Formulary)

  • Non-maintenance (All network pharmacies): Up to a 34-day supply or 100 units (whichever is less), one retail co-payment per prescription or refill prescription
  • Maintenance (For drugs on the SWHP Maintenance Drug List, SWHP pharmacies only): Up to a 90-day supply or 360 units (whichever is less), one maintenance co-payment per prescription or refill prescription

More Pharmacy Benefit Information

Log in for access for:

  • Pharmacy claim information
  • Pharmacy deductible information
  • Explanation of benefits
  • Drug information and pricing

*This function is not available for SeniorCare or the Medicare Part D membership.

Prescription Refills and Transfers

Fill out and submit one of these forms if you need a prescription refill or transfer.
Pharmacy Prescription Refill Form
Mail-order prescriptions are handled by the Salado Pharmacy.
P.O. Box 1287, Salado, TX 76571 
1-800-707-3477 or 254-947-7555 

Find a Scott & White Health Plan pharmacy in your area.
Scott & White Health Plan pharmacies

Drug List

The drug listings (formularies) below are updated each month.