If your doctor has prescribed a medication that’s in the SCAN Formulary but is on a higher tier than you can afford, it’s best to talk with your doctor first. There may be a medication that would work with both your treatment plan and your budget.

If there isn’t, it may be possible to get the higher-cost medication for less. There are a few conditions that must be met, though:

• The medication can’t be on Tier 5 of the SCAN Formulary.
• It can’t be a brand-name drug on Tier 3.
• It can’t be a non-Formulary drug that SCAN has already approved for you.
• There must be other drugs that treat your condition on the lower tiers in the SCAN Formulary that your doctor can show don’t work or are appropriate for you.

If your medication meets these conditions, you can ask for a lower copayment. Call SCAN Member Services to get this process started.

If you are having trouble paying for your prescription medications, call “Extra Help” to apply for low-income assistance: 1-866-866-1785.

If you do not receive “Extra Help” from Medicare, you may be able to get assistance paying for certain HIV prescription medications through the AIDS Drug Assistance Program (ADAP).

For more information about the program, eligibility criteria, covered drugs, or how to enroll in the program, please call:

Review the ADAP website listed below for additional information:

For PrEP related information, please visit:

A: Doctors need to have a full picture of their patients’ lives so they can help anticipate any issues that may impact their health, including aspects of their personal life and relationships. Not only does this help your doctor fully understand and address potential risks, but it should also make your appointments more comfortable. That’s good for your health, too, because you’re more likely to continue your care when it’s a positive experience.

A: Your doctor is bound by law to keep your personal information confidential. Under the federal law known as HIPAA, it’s illegal for healthcare providers to share patients’ treatment information without their permission.

A: Your healthcare team may not know what language to use unless you tell them. Explain the terms you prefer so your doctor and the staff can start using them. It’s one thing if they just didn’t know. But if you feel it’s intentional, disrespectful, or discriminatory, that’s another. And if that’s the case, please contact SCAN Member Services and tell us what’s happened.

A: We use the information members provide on the Health Risk Assessment in two ways: 1) to connect members with programs and services that support their individual health needs, and 2) on a larger perspective, to be able to see where we can better serve our members. The more we know about the issues in our members’ lives that can affect their physical and mental health, the better job we can do of developing services and programs that make a difference to their health and wellbeing.

Know that you don’t have to answer these questions—your SCAN benefits and coverage will not be affected in any way if you don’t. But we hope you will trust us with this information.

A: Yes, SCAN covers medications for PrEP. Some examples include Descovy tablets and the generic equivalent to Truvada, emtricitabine and tenofovir disoproxil fumarate (TDF) tablets. Apretude (cabotegravir) is the first injectable medication for PrEP that is approved by the Food and Drug Administration (FDA). Apretude is injected by a healthcare provider once monthly for 2 months, then every 2 months. Talk to your doctor about requesting this medication from your Medical Group.

PrEP is a drug treatment for HIV-negative people that protects against exposure to HIV. The federal government recommends that it be prescribed for people who are at substantial risk of contracting HIV. Talk to your doctor about possible side effects when comparing these medications and to determine if any of them are appropriate for you, as well as other options for preventing HIV transmission.

A: Drug companies that make generic alternatives to brand-name medications can generally sell the generic versions for lower prices because they didn’t have to pay for the research and development that brought the drug to market in the first place. There are situations, though, when the price doesn’t drop as much as expected. That’s the case with emtricitabine and TDF, the generic for Truvada. At a retail price of more than $830 per month, it qualifies for a Tier 5, Specialty Tier pricing.

A: All classes of medications for HIV treatment are covered by SCAN for applicable copayments or coinsurance amounts.

Yes, these medications are in the SCAN Formulary and are covered for medically necessary hormone therapy for transgender community. Some of the medications may require prior authorization. You or your doctor will first need to submit a request for coverage for these medications. For additional information, see the SCAN Formulary.

A: If your doctor prescribes a medication that’s in the SCAN Formulary but is on a higher tier than you can afford, it’s best to talk with your doctor first. There may be a medication that would work with both your treatment plan and your budget.

If there isn’t, it may be possible to get the higher-cost medication for less. There are a few conditions that have to be met, though:

• The medication can’t be on Tier 5 of the SCAN Formulary.
• It can’t be a brand-name drug on Tier 3.
• It can’t be a non-Formulary drug that SCAN has already approved for you.
• There must be other drugs that treat your condition on the lower tiers in the SCAN Formulary that your doctor can show don’t work or are inappropriate for you.

If your medication meets these conditions, you can ask for a lower copayment. Call SCAN Member Services to get this process started.

If you’re having trouble paying for your prescription medications, call “Extra Help” to apply for low-income assistance: 1-866-866-1785.

If you do not receive “Extra Help” from Medicare, you may be able to get assistance paying for certain HIV prescription medications through the AIDS Drug Assistance Program (ADAP).

For more information about the program, eligibility criteria, covered drugs, or how to enroll in the program, please call:

AZ: 1-800-334-1540
CA: 1-844-421-7050
NV: 1-775-684-4200
TX: 1-800-255-1090

Review the ADAP website listed below for additional information:

AZ: http://www.azdhs.gov/phs/hiv/adap/index.htm
CA: https://www.cdph.ca.gov/Programs/CID/DOA/Pages/OAmain.aspx
NV: https://dpbh.nv.gov/Programs/HIV-Ryan/Ryan_White_Part_B_-_Home/
TX: https://www.dshs.texas.gov/hiv-std-program/texas-dshs-hiv-std-program-texas-hiv-medication-program/texas-hiv-medication-program-7

For PrEP related information, please visit:

AZ: ADHS - HIV Prevention Program - PrEP and PEP (azdhs.gov)
CA: PrEP Assistance Program (PrEP-AP) Benefits (ca.gov)
NV: https://dpbh.nv.gov/Programs/HIV/dta/FAQs/HIV_-_FAQs/
TX: https://www.dshs.state.tx.us/hivstd/prep/