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Pharmacy Information

escripts logoPharmacy Information - Link to Express Scripts, Inc. Sanford Health Plan Members with pharmacy benefits may review their pharmacy coverage, find drug information and locate pharmacies.


Pharmacy Directory

Attention Members: Please refer to your Policy for details about requesting an exception to the formulary. Your Policy also includes state mandated formulary benefits and quantity limits.

Generic Medication Information

IMPORTANT NOTICE

Walgreens Remains a Non-Participating Pharmacy in the Sanford Health Plan Pharmacy Network
Sanford Health Plan contracts with Express Scripts Inc. as its vendor for processing and paying pharmacy claims and accessing its network of 60,000 pharmacies nationwide. Last fall Walgreens made the business decision to no longer partner with Express Scripts due to payment disputes. They also participated in a widespread disparaging public campaign that was detrimental to our partner, Express Scripts, and caused undue concern with our clients and members while the termination was underway. 

During this past year, Express Scripts and Walgreens came to an agreement on their contractual disputes. However, Sanford Health Plan’s priority is to maintain relationships with committed partners whose primary objective is to take care of our members.  Those pharmacies that remained in the network last year during the Walgreens dispute were committed to our members and the communities we serve and specifically provided programs to meet our members’ needs (fills and transfers) in a courteous and easy manner.  Consequently, Sanford Health Plan has made the decision not to add Walgreens back into our network.  We have ensured that there is more than adequate access to pharmacies who value our business and our members.

An analysis of our current utilization provided the following talking points in support of our decision:

1. Sanford Health Plan’s goal is to ensure our members continue to have access to participating pharmacies. Analysis of our membership data shows that even without Walgreens in our network, each of our members still will have access to another participating pharmacy within 2-3 miles of their place of residence. 

2. More than 98% of our members have access to another participating pharmacy within one mile of their residence and over 99% have access within two miles.

3. Sanford Health Plan worked closely with our pharmacies and members to transfer their prescriptions from a Walgreens pharmacy to a new participating pharmacy of their choice earlier this year.

4. The copayment or coinsurance amounts our members pay for their pharmacy benefit remain unchanged when members receive drugs from a participating pharmacy.

Sanford Health Plan Members who choose to begin receiving their prescription drugs from a Walgreens pharmacy will not have insurance coverage to help pay for the cost of their drugs. If you have questions or concerns, please contact our Utilization Management Department at (800) 805-7938.


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. The Formulary is a list of medications that are most effective for the treatment of a disease according to the clinical judgment of the physicians, healthcare providers, and pharmacists who helped us develop the Formulary. 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.

You may fill out a Medication Request form online:

For medication safety, visit www.AHRQ.GOV.

 

If you have questions, please contact our Health Services Department at 605-328-6807 or toll free at 1-800-805-7938.