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Prescription

Prescription coverage is included with all of our medical plans.

See below for 2024 details.

How It Works
Your prescription drug coverage is tied to your medical plan.

Save money by using a BSW pharmacy! Choose from 30+ BSW pharmacies, a dedicated specialty pharmacy and 24/7 kiosks. Or use a pharmacy from our nationwide contracted network.
Coverage under SEQA Plan
  • You pay copays or coinsurance for prescription drugs from day one.
  • You can pair with the general-purpose FSA to help pay for prescriptions.
Coverage under EQA Plan
  • You pay copays or coinsurance for prescription drugs from day one.
  • You can pair with the general-purpose FSA to help pay for prescriptions.
Coverage under PPO Plan
  • You pay copays or coinsurance for prescription drugs from day one. 
  • You can pair with the general-purpose FSA to help pay for prescriptions.
Coverage under HSA Plan

What You Pay

What you pay for prescription medications depends on your medical plan and the category, or drug tier, of the medication.

Full details are on the Baylor Scott & White Health Plan pharmacy page.

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Terms to Know
We know that health and insurance benefits can be difficult to understand, so we've gathered a few commonly used terms that are often used when navigating your benefit plans. Below are two common pharmacy terms. You can also view the full Benefits Glossary
Drug coverage

Keep in mind that the Group Value Formulary designation includes those drugs covered under our plan and approved by BSW physicians and healthcare providers.

Prior authorization
The following categories require prior authorization. You, your doctor or a representative may submit a request for coverage.
  • Drugs not listed on the formulary list will need prior authorization before the plan will cover them, for safety and cost reasons.
  • If you fill a prescription for a brand name drug when a generic is available, prior authorization will be required for coverage of the drug at the applicable non-preferred or specialty copay.

Ways to Save

  • Choose generic medications when possible.

    • The new Member Choice Program requires generic medication fills when available. If a brand name medication is requested (when a generic is available), you will pay the non-preferred member cost share plus the difference in cot between the brand name and generic equivalent drug. 

  • Fill your prescriptions at a BSW pharmacy to save money and gain convenience.

    • Maintenance-eligible drugs: 90-day supply is available for the cost of only two copays, either in-store or through mail order.
    • Preferred generics: 30-day supplies are $5 (compared to $12 at a contracted pharmacy)
    • Over-the-counter medications: 20% discount when you show your employee badge.

  • Use your tax-free savings account. 

    • SEQA/EQA or PPO Plans: Use funds from a General-purpose Flexible Spending Account (FSA) to pay for prescription drugs and over-the-counter drugs prescribed by a physician.
    • HSA Plan: Use funds from the Health Savings Account (HSA) to pay for prescription expenses.
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  • Pharmacy Documents

    Visit Baylor Scott & White Health Plan pharmacy page for more information about each drug tier and what prescriptions are included, such as:

    • Group Value Formulary
    • Chronic and Preventive Medication List
    • Quantity Limits: Group Value and Group Choice
    • Monthly Drug Formulary Changes
    • Drug Requests: Prior Authorizations, Exceptions and Appeals
    Go to BSWHP > Pharmacy

This site summarizes the programs and benefits available to employees and their eligible dependents. Official plan documents, policies and certificates of insurance that contain the details, conditions, maximum benefit levels and restrictions on benefits govern our benefits program and are available on this site. In case of a conflict between this site and the official documents, the official documents prevail. The information on this site isn't a guarantee of benefits. Baylor Scott & White reserves the right to modify or terminate its employee benefit plans and programs at any time for any reason.

Click here if you have feedback on the website or need to report an issue. All other questions and issues, please contact the corresponding resource on the Need Help page.

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