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Formulary data updated on 12-03-2024

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was not found in the formulary, but the following alternative drugs are:

(These are suggested alternatives. Please ask your doctor if they are appropriate for you. This is not a complete list of all formulary alternatives covered by our Plan for the drug you have selected.)

Sorry, we couldn't find a drug that matches your search criteria.

Please contact Member Services and ask if your drug is covered. If you learn that our plan does not cover your drug, you can ask for an exception to cover your drug. Please select "How to request an exception?" for more information about how to request an exception.

Having trouble finding what you’re looking for?

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(877) 452-5898 TTY: (888) SCAN-TTY

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Show Hide Paxlovid Coverage

Paxlovid is covered by SCAN at no cost to you even if you haven't paid your deductible, if your plan has a deductible.

Show Hide 2025 Part D Vaccine Coverage

Our SCAN plans cover most Part D vaccines, including shingles, tetanus and travel vaccines, at no cost to you. Call Member Services for more information.

Our VillageHealth plans cover most adult Part D vaccines, including shingles, tetanus and travel vaccines, at no cost to you, even if you haven’t paid your deductible. Call Member Services for more information.

Our Strive plans cover most adult Part D vaccines, including shingles, tetanus and travel vaccines, at no cost to you, even if you haven’t paid your deductible. Call Member Services for more information.

Show Hide 2024 Part D Vaccine Coverage

Our SCAN plans cover most Part D vaccines, including shingles, tetanus and travel vaccines, at no cost to you. Call Member Services for more information.

If you are enrolled in a Strive plan and receive “Extra Help” from Medicare, most Part D vaccines, including shingles, tetanus and travel vaccines, are covered by our plan at no cost to you. Call Member Services for more information.

Show Hide 2025 Part D Insulin Coverage

You won’t pay more than $35 for a one-month supply of each insulin product covered by our SCAN plans, no matter what cost-sharing tier it’s on.

You won’t pay more than $0 or $4.80 or $12.15 for a one-month supply of each insulin product covered by our SCAN Connections and SCAN Connections at Home plans, no matter what cost-sharing tier it’s on.

You won’t pay more than $35 for a one-month supply of each insulin product covered by our VillageHealth plans, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.

You won’t pay more than $35 for a one-month supply of each insulin product covered by our Strive plans, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.

Show Hide 2024 Part D Insulin Coverage

You won’t pay more than $35 for a one-month supply of each insulin product covered by our SCAN plans, no matter what cost-sharing tier it’s on.

You won’t pay more than $0 for a one-month supply of each insulin product covered by our SCAN Connections and SCAN Connections at Home plans, no matter what cost-sharing tier it’s on.

You won’t pay more than $35 for a one-month supply of each insulin product covered by our VillageHealth plans, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.

You won’t pay more than $35 for a one-month supply of each insulin product covered by our Strive plans, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible. If you receive “Extra Help,” you pay $0 for each insulin product covered by our plan.

Show Hide 2025 Enhanced Drug Coverage (Generic Viagra & Select Prescription Vitamins)

If you are enrolled in a SCAN plan listed below, these drugs are covered for you on tier 1:

Generic Viagra (sildenafil 25mg, 50mg, 100mg tab with a maximum 4 tabs/month or 49 tablets/year)
Cyanocobalamin (Vitamin B12) inj 1000mcg/ml
Ergocalciferol (Vitamin D2) caps 1.25mg/50,000 units
Folic acid (Vitamin B9) tabs 1mg

These prescription drugs are not normally covered in a Medicare Prescription Drug Plan. The amount you pay when you fill a prescription for these drugs does not count towards your out-of-pocket costs. In addition, if you are receiving extra help to pay for your prescriptions, you will not get any extra help to pay for these drugs.

SCAN Plans with Enhanced Drug Coverage (the coverage of these drugs is not available in other SCAN plans):

SCAN Classic (HMO): Los Angeles, Orange, Riverside, San Bernardino, Ventura, San Diego, Alameda, San Mateo, Fresno, Madera, Clark, Nye, Maricopa, Pima, Pinal, Bexar, Harris, Bernalillo, Sandoval Counties
SCAN Allied (HMO): Los Angeles, San Francisco, San Mateo Counties
SCAN Alta (HMO): San Diego County
SCAN Prime (HMO): Los Angeles, Orange, San Bernardino Counties
SCAN Venture (HMO): Los Angeles, Orange, Riverside, San Bernardino, Maricopa, Pima, Pinal, Counties
SCAN Affirm (HMO): Los Angeles, Orange, Riverside, San Diego, San Francisco Counties
SCAN Inspired by women for women (HMO): Los Angeles and Orange Counties
SCAN MyChoice (HMO): Orange, Los Angeles, Riverside, San Bernardino, San Diego, Alameda, San Mateo, Fresno, Madera, Santa Clara, Stanislaus, San Francisco, Maricopa, Pima, Pinal, Bernalillo, Sandoval, Bexar, Harris, Clark Counties
SCAN Compass (HMO): Clark, Nye Counties
SCAN Retiree Groups

Show Hide 2024 Enhanced Drug Coverage (Generic Viagra & Select Prescription Vitamins)

If you are enrolled in a SCAN plan listed below, these drugs are covered for you on tier 1:

Generic Viagra (sildenafil 25mg, 50mg, 100mg tab with a maximum 4 tabs/month or 49 tablets/year)
Cyanocobalamin (Vitamin B12) inj 1000mcg/ml
Ergocalciferol (Vitamin D2) caps 1.25mg/50,000 units
Folic acid (Vitamin B9) tabs 1mg

SCAN Plans with Enhanced Drug Coverage (the coverage of these drugs is not available in other SCAN plans):

SCAN Classic (HMO): Los Angeles, Orange, Riverside, San Bernardino, Ventura, Alameda, San Mateo, Fresno, Madera, Clark, Nye, Maricopa, Pima, Pinal, Bexar, Harris, Bernalillo, Sandoval Counties
Scripps Classic offered by SCAN Health Plan (HMO): San Diego County
Scripps Signature offered by SCAN Health Plan (HMO): San Diego County
SCAN Alta (HMO): San Diego County
SCAN Prime (HMO): Los Angeles, Orange, Riverside, San Bernardino Counties
SCAN Options (HMO): Ventura County
SCAN Venture (HMO): Los Angeles, Orange, Riverside, San Bernardino, Clark, Nye, Maricopa, Pima, Pinal, Bexar, Harris Counties
SCAN Affirm (HMO): Los Angeles, Orange, Riverside, San Diego, San Francisco Counties
SCAN Inspired by women for women (HMO): Los Angeles and Orange Counties
SCAN MyChoice (HMO): Orange, San Diego, Alameda, San Mateo, Clark Counties
SCAN Navigate (HMO): Los Angeles, Orange, Riverside, San Bernardino Counties
SCAN Compass (HMO): Los Angeles, Orange, Riverside, San Bernardino, Clark and Nye Counties
SCAN Retiree Groups

Show Hide Disclaimer And Additional Information

What is the Comprehensive Formulary?

A formulary is a list of covered drugs selected by SCAN in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. SCAN will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a SCAN's network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.

SCAN covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs.

The Medicare program allows us to make changes in our prescription drug formulary list at any time during the calendar year. As previously explained, the formulary is a list of drugs. A change in our drug formulary could affect which drugs are covered, the members co pay and the limit on usage.
Get a copy of the Formulary or look up a medication online.

A copy of our Formulary along with recent changes can be downloaded at the links below. Or, if you prefer, we will mail you a copy of the most recent version. Just contact our Member Services department by email or phone:
Email: memberservices@scanhealthplan.com

Call Member Services at 1-800-559-3500 (TTY: 711) for additional information. (TTY: 711). Hours are 8 a.m. to 8 p.m., seven days a week from October 1 to March 31.

From April 1 to September 30 hours are 8 a.m. to 8 p.m. Monday through Friday. Messages received on holidays and outside of our business hours will be returned within one business day.

This formulary services the counties covered under the SCAN service area. For a complete listing of covered areas, click here. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

How do I request an exception to the SCAN's Formulary?

You can ask SCAN to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make.

You can ask us to cover a drug even if it is not on our formulary. If approved, this drug will be covered at a pre-determined cost-sharing level, and you would not be able to ask us to provide the drug at a lower cost-sharing level.

You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, SCAN limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover a greater amount.

Generally, SCAN will only approve your request for an exception if the alternative drugs included on the plan’s formulary, or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects.

You should contact us to ask us for an initial coverage decision for a formulary, or utilization restriction exception. When you request a formulary, or utilization restriction exception, you should submit a statement from your prescriber or physician supporting your request. Generally, we must make our decision within 72 hours of getting your prescriber’s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we get a supporting statement from your doctor or other prescriber.

How to request an exception to SCAN's Formulary? For more information click here.

The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Select a plan to download the Formulary Drug List Select Plan

2025 SCAN Health Plan Formulary (English/Spanish)

2025 SCAN Health Plan Formulary (English/Chinese)

2025 SCAN Health Plan Formulary (English\Korean)

2025 SCAN Connections (HMO D-SNP) and SCAN Connections at Home (HMO D-SNP) Formulary (English/Spanish)

2025 SCAN Connections (HMO D-SNP) and SCAN Connections at Home (HMO D-SNP) Formulary (English/Chinese)

2025 SCAN Connections (HMO D-SNP) and SCAN Connections at Home (HMO D-SNP) Formulary (English/Korean)

2025 SCAN Desert Health Plan Formulary (English\Spanish)

2025 SCAN Health Plan Formulary - Clark and Nye Counties (English/Spanish)

2025 SCAN Health Plan Formulary - Texas (English/Spanish)

2025 SCAN Health Plan Formulary - New Mexico (English/Spanish)

2025 VillageHealth Formulary - Los Angeles/Riverside/San Bernardino County (English/Spanish)

2024 SCAN Health Plan Formulary (English/Spanish)

2024 SCAN Health Plan Formulary (English/Chinese)

2024 SCAN Health Plan Formulary (English\Korean)

2024 SCAN Connections (HMO D-SNP) and SCAN Connections at Home (HMO D-SNP) Formulary (English/Spanish)

2024 SCAN Connections (HMO D-SNP) and SCAN Connections at Home (HMO D-SNP) Formulary (English/Chinese)

2024 SCAN Connections (HMO D-SNP) and SCAN Connections at Home (HMO D-SNP) Formulary (English/Korean)

2024 SCAN Desert Health Plan Formulary (English\Spanish)

2024 SCAN Health Plan Formulary - Clark and Nye Counties (English/Spanish)

2024 SCAN Health Plan Formulary - Texas (English/Spanish)

2024 SCAN Health Plan Formulary - New Mexico (English/Spanish)

2024 VillageHealth Formulary - Los Angeles/Riverside/San Bernardino County (English/Spanish)

Show Hide SCAN Rx Savings Finder Tool

The SCAN Rx Savings Finder Tool lets you search for pharmacy coupons to find the biggest savings for your medication. Use this tool to find coupons for drugs that are excluded from Medicare coverage or to compare your SCAN copay with coupon prices. Simply enter your zip code, the name of your medication, and the tool will show a list of pharmacies near you and the lowest price available with the coupon. You can then print, email, text, or show the pharmacist the coupon on your phone.

Note: If you choose to purchase your medication using a third-party prescription discount coupon found in the SCAN Rx Savings Finder Tool, your SCAN health insurance will not be billed and the amount you pay will not count toward any deductible or other out-of-pocket costs.

Show Hide Calculator to estimate drug costs

Check out SCAN’s new prescription drug cost calculator. This simple tool lets you select your medications and estimate costs based on SCAN plans—and even explore lower-cost alternatives.

Let's get started

Helpful Links

How to Request a Formulary Exception
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Find Covered Drugs

An Error Occurred

Having trouble finding what you’re looking for?

Search by medication name, first letter, or filters to find a drug.

was not found in the formulary, but the following alternative drugs are:

(These are suggested alternatives. Please ask your doctor if they are appropriate for you. This is not a complete list of all formulary alternatives covered by our Plan for the drug you have selected.)

was not found in the formulary, but the following alternative drugs are:

Sorry, we couldn't find a drug that matches your search criteria.

Having trouble finding what you’re looking for?

Show Hide Paxlovid Coverage

Show Hide 2025 Part D Vaccine Coverage

Show Hide 2024 Part D Vaccine Coverage

Show Hide 2025 Part D Insulin Coverage

Show Hide 2024 Part D Insulin Coverage

Show Hide 2025 Enhanced Drug Coverage (Generic Viagra & Select Prescription Vitamins)

Show Hide 2024 Enhanced Drug Coverage (Generic Viagra & Select Prescription Vitamins)

Show Hide Disclaimer And Additional Information

Show Hide SCAN Rx Savings Finder Tool

Show Hide Calculator to estimate drug costs

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Find Covered Drugs

An Error Occurred

Having trouble finding what you’re looking for?

Search by medication name, first letter, or filters to find a drug.

was not found in the formulary, but the following alternative drugs are: (These are suggested alternatives. Please ask your doctor if they are appropriate for you. This is not a complete list of all formulary alternatives covered by our Plan for the drug you have selected.)

was not found in the formulary, but the following alternative drugs are:

Sorry, we couldn't find a drug that matches your search criteria.

Having trouble finding what you’re looking for?

Helpful Links

Have questions about Medicare?

Give us a call. We can help.

was not found in the formulary, but the following alternative drugs are:

(These are suggested alternatives. Please ask your doctor if they are appropriate for you. This is not a complete list of all formulary alternatives covered by our Plan for the drug you have selected.)