Close

Sanford Health Plan

Sanford Health Plan

Pharmacy Information

Pharmacy Information Sanford Health Plan Prior Authorization Member Rights - Sanford Health Plan

The Sanford Health Plan Formulary is a list of medications that are the most effective for the treatment and diagnosis of disease and maintenance of health according to the clinical judgment of the physicians, pharmacists and other health care professionals who serve on the Physicians Quality Committee that approved the formulary.

For a complete listing of the formulary, pharmacy management procedures (including things like generic substitution, prior authorization, step therapy protocols etc.) and benefit information, please visit your mySanfordHealthPlan portal where you can find the following:

  • Summary of Pharmacy Benefits Booklet
  • Formulary (list of approved drugs)
  • Your Summary of Benefits and Coverage
  • Your Plan Policy, which includes details about requesting an exception to the Formulary as well as state mandated formulary benefits and quantity limits
  • Medication Request Form
  • Link to Express Scripts, Inc. website where you can find additional information including:
    • Pharmacy locations
    • Health news
    • Generic substitution
    • Drug side effects and interactions
    • Price checks and benefit information, including your financial responsibility for your prescription drugs
    • Your current medication usage

View our full Pharmacy Network Directory where you can find a list of participating pharmacies

What If Your Prescription Drug Is Not On The Formulary?

Sanford Health Plan uses a Formulary to help you save money and help control the costs of healthcare. Of course, not all drugs are included in the formulary. However, we understand that sometimes exceptions must be made. Under the following circumstances, Sanford Health Plan will provide you with a Medication Request Form if you feel an exception must be made to our Formulary.

  • You or your physician feel it's medically necessary to allow you to take a drug that is not listed on our formulary; or
  • You have tried our Step Therapy program and cannot tolerate the side effects or the use of the Step Therapy drugs are counter-indicated and you would like authorization for coverage of those drugs.

If you feel that Sanford Health Plan should consider coverage of a medication based on medical necessity for a medication not on the Formulary, please follow the Exception to Formulary Process in your Plan Policy.  You may also visit mySanfordHealthPlan to access and complete the online Medication Request Form.

If you have questions, you may also contact our Pharmacy Department.

happy mother and baby laying in meadow

Tell Us About Yourself

Insurance terms are confusing. Let us help make sense of it all.

Purchasing through Sanford Health Plan or the Marketplace, let us explain the differences

+ Add Another
thumbnial graphic for step 2

Tell Us About Yourself

Insurance terms are confusing. Let us help make sense of it all.

Purchasing through Sanford Health Plan or the Marketplace, let us explain the differences

thumbnail graphic for step 3

Tell Us About Yourself

Insurance terms are confusing. Let us help make sense of it all.

Purchasing through Sanford Health Plan or the Marketplace, let us explain the differences

Sanford Health Plan offers two different provider network products in your area. Select what option that best fits your needs.

Click here to search our provider directory. If your doctor does not display, they most likely are not a participating provider with Sanford Health Plan. Feel free to continue the Plan Picker tool if you are still interested in what options Sanford Health Plan has to offer. If not, we appreciate you using our Plan Picker!

Please complete all steps in the questionnaire to see your results.