Explanation of Benefits
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:
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.
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.