Disclaimer: The formulary list is a guide providing tier designation for common medicines within select therapeutic categories.
The results below may not include all drugs covered by your prescription drug benefit. Generic medicines are available within
many of the therapeutic categories listed, in addition to categories not listed, and should be considered as the first line of prescribing. The medications in the PA program may change at any time
as deemed appropriate by Southern Scripts. Brands with generic equivalents available will automatically require a prior authorization dependent on the "Dispense As Written"
Code indicated on the prescription and processed by the pharmacy.
This Plan provides benefits for numerous medications, however not all specialty drugs are covered under the Plan. In order to assist you in determining if benefits are available for the
medication prescribed for you, please refer to the list below. If the prescribed medication is not covered by the Plan, you may qualify for the drug manufacturer’s patient assistance program, or
other alternative funding, which can significantly lower your cost. In order to aid you with navigating and obtaining any financial assistance that is available, the Plan has engaged the services
of Payer Matrix at no cost to you. Payer Matrix is a specialty drug cost containment company which will work on your behalf. For additional information regarding this benefit, please contact Payer
Matrix at 1 (877) 305-6202.
Note: Your doctor most likely will not be aware of which medicines are covered under this Plan’s specific formulary, or those for which coverage is unavailable. If you notice that one of your medications
is not covered, or has gotten more expensive, be sure to ask your doctor about any alternative medications that may be more affordable.