Formulary

Our formulary is our list of covered generic and brand-name prescription drugs for plans that have prescription drug coverage To view the formulary you can:

• Download the formulary (please note, this formulary may change)
  • 2023 plans formulary (English)
  • 2023 plans formulary (En Español)
• Request a printed directory by emailing
  • PharmacyMedicar@yoursummithealth.com
• Call Pharmacy Customer Service
  • 844-827-2355 (TTY users, please call 711)

If you do not see the drug you are looking for in the formulary, please call our pharmacy customer service. We may cover that drug.

Search the online benefit tool for prescription drugs*

With this tool you can:

• Search for a drug to see if it’s covered,
• Get a prescription drug cost estimate may be,
• See if there is an alternative drug available,
• Find the price and location of pharmacies near you,
• Check the price or option for mail order.

If you’re a current Summit Medicare Advantage member, please access the online benefit tool for prescription drugs through your Summit Member Dashboard for a more accurate cost estimate that accounts for your personal claims. 

Follow these steps to use the online tool

1. Select one of the plan names, below
   • A new window will open with the online benefit tool for prescription drugs
     
     
2. Enter a drug name
   
   
3. Provide the quantity and the number of days
   
   
4. Enter your ZIP code

Select your plan to start the online tool

2023 plans

2023 Summit Health Core (HMO-POS)
2023 Summit Health Value + Rx (HMO)
2023 Summit Health Standard + Rx (HMO-POS)
2023 Summit Health Premier + Rx (HMO-POS)

*Prescription drug information displayed on the online benefit tool is subject to change without notice and is not a guarantee of benefits. Your coverage is based on your plan benefit and eligibility at the time of service. If you have copay assistance it may affect your deductible and/or your maximum out of pocket amount. Coverage and cost sharing may vary for preventive service.

Preferred diabetic devices and supplies

Summit Health covers the following preferred diabetic devices and supplies.

Please refer to your Evidence of Coverage (EOC) for your benefits and plan rules.

**Diabetic devices and supplies are covered through your Part B (medical) Medicare benefits. There may be prior authorization requirements and quantity limits. “Preferred” products do not guarantee coverage. We will not cover other brands and manufacturers for Part B diabetic devices and supplies unless your provider tells us that a different brand is appropriate for your medical needs. However, if you are new to our plan and are using a different brand, we will continue to cover that brand for you for up to 90 days. During this time, you should talk with your doctor to decide what brand is medically appropriate for you after the 90-day period.

Pharmacy customer service

Please call our Summit Health Customer Service at 844-827-2355 (TTY users, please call 711). Customer Service is available to help you from 7 a.m. to 8 p.m., Pacific Time, seven days a week from Oct. 1 to March 31. After March 31, your call will be handled by our automated phone system on weekends and holidays. Weekend calls are forwarded to voicemail and returned the next business day.

Formulary updates

• Adding or removing drugs. This happens if a drug is recalled or not working, or a new drug becomes available
• Moving a drug to a higher or lower cost-sharing tier
• Adding or removing a restriction on coverage
• Replacing a brand-name drug with a generic drug

If we make changes to a drug you are taking, we will send you a notice. We will also post any changes for our formulary, with dates, on this page.

Formulary exceptions

To request a prescription drug coverage determination, redetermination, or prior authorization, see our pharmacy coverage determination.