Scott & White Health Plan

Why should I use generic medications?
Essentially, generic medications are brand-name drugs that have lost patent protection. All generic medications were at one time brand name drugs. The Food and Drug Administration (FDA) still oversees all aspects of generic manufacturing, and generics must meet the exact same specifications as their brand name counterparts making them as safe and effective. Generics also contribute to cost savings for you and your employer.

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How are medications selected for the Preferred Drug List?
The medication must be safe in order to be even considered. To reduce the possibility of dangerous medications being added to the list, Scott & White has a policy that a medication must be available to the general market for a minimum of six months before put in the review process. Each medication is then reviewed and compared against other medications that treat the same condition. If all factors are the same, the most cost effective agent will be placed on the preferred drug list. However, this does not mean that high cost agents will be restricted from the list. If a medication is truly better, it will be added.

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3.

My medication is not on my employer's Preferred Drug List, what should I do?
If your physician is prescribing a medication not on your employer's preferred drug list, you have some options. You can take a copy of your Preferred Drug list to the doctor and ask that it be placed in your patient chart. This will increase the chances that your prescribing physician will choose a preferred medication. In almost every case, an agent to treat your condition will be on the preferred drug list. In some cases, over-the-counter products may be your best option. You can consult your local pharmacist about some cost saving options. And, of course, you can always get the medication your physician has prescribed and pay the higher co-pay amount.

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4.

What do the symbols on my employer's Preferred Drug List mean?
You will see several symbols on your preferred drug list, typically to the right of the name of the medication

• "A" means the medication is a generic and you will pay the generic co-pay amount
• "B" means that the medication is a preferred drug and you will pay the preferred co-pay amount
• "M" means that the medication is considered a maintenance medication and qualifies for the maintenance benefit (i.e. three month supply for two co-pay amounts). Maintenance drugs are coded as such if they meet the following criteria:
  • Medications that do not require frequent monitoring and dosage adjustments for side effects or therapeutic responses.
  • Certain drugs that may have potential life-threatening toxicity when taken as an intentional overdose may be excluded.
  • Medications that are used to treat a chronic condition with no therapy endpoint. These drugs are taken continuously but do not provide a cure for the condition for which it is being treated.
  • Medications that are typically used as outpatient type of drugs.
• "P" means the drug requires prior-authorization, meaning that your physician needs to communicate with us regarding medical necessity before your prescription can be filled for a co-pay by your pharmacy.
• The dollar symbols ($) indicate relative cost to your employer, not your co-pay amount. This is important for you because your employer is self-funded, meaning that your premiums and the money the employer pays on your behalf pay all the claims. As claim amounts increase over time, premiums usually have to increase.

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What if I prefer to take the brand instead of the generic?
Many employers allow employees to take a brand drug when a generic is available, but in most cases, the employee will pay a higher cost for this.

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What is my Scott and White Prescription Service's PCN number?
02500000

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What is my Scott and White Prescription Service's BIN number?
610141

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How do I receive a copy of my prescription records?
Fill out a release of pharmaceutical information form and either fax it to 254-298-6186 or mail to: Attention: Reporting Department, Scott and White Prescription Services, 4236 Lowes Drive, Temple, TX 76502.

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How do I seek reimbursement for covered medications?
Fill out a direct member reimbursement form and either fax it to 254-298-6186 or mail to: Attention: Customer Services Department, Scott and White Prescription Services, 4236 Lowes Drive, Temple, TX 76502

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If I change pharmacies, do I need to get a new prescription?
No, you can transfer your prescription.

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How do I transfer a prescription to a Scott & White Pharmacy?
Three options are available for transferring prescriptions:

1. The best way to transfer a prescription is to go to www.hillcrest.swhp.org:
   • Choose the link on the left "Prescription Refills/Transfers."
   • Click the pill bottle, and you will be provided a page to fill out your personal information as well as the information of the pharmacy you are requesting to transfer from.
   • Please allow 24 hours to complete the transfer.
   • If the prescription is expired or needs physician intervention, please allow an additional 72 hours for refills.
2. If you do not have access to the internet, you may also call the pharmacy where you would like your prescription filled. Please have the following information ready when calling:
   • name
   • date of birth 
   • daytime phone number
   • prescription number from previous pharmacy
   • previous pharmacy name and phone number
   • drug name
3. You may bring your prescription bottle to the pharmacy

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What drugs are eligible for a 90 day supply?
Any drug listed with an "M" on the preferred drug list can be dispensed for 90 days at ANY local Scott & White Health Plan Pharmacy location, if written as such by your physician.

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What drugs are allowed for a zero copay?
Certain drugs are available for ZERO COPAY; a combination of three criteria make a drug eligible:

1. The drug must be generic. These drugs will be listed in lower case letters with a "A" beside the name of the drug.
2. The drug must be eligible for the maintenance (i.e. 90 day) benefit. These drugs will be listed with an "M" on the preferred drug list. Look for both "A" and "M" symbols. There is a key at the bottom of your preferred drug list to help explain these indicators.
3. These prescriptions must be filled at a Scott & White Health Plan Pharmacy location.

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Who do I contact about my pharmacy benefit?
You can contact Scott & White Prescription Services at 800-728-7947 Monday thru Friday 8:00 am to 6:00 pm.

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