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Prescription

Prescription coverage is included with all of our medical plans.

See below for 2025 details.

New for 2025

Your prescription coverage is tied to your medical plan, but your benefit will now be managed by Rightway. Rightway has a dedicated pharmacy team that offers personalized support for all your pharmacy needs.

Important: You will receive a new medical/prescription ID card to your home address in December that MUST be used beginning in 2025.

What you pay

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

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Ways to save

  • Choose generic medications when possible. 

  • Use BSW pharmacies:

    • 30+ pharmacies, including a dedicated specialty and mail-order pharmacy. To set up mail order, call 855.388.3090, Monday – Friday, 7 AM to 7 PM
    • 90-day maintenance medications available at a reduced cost
    • 20% discount on over-the-counter medications with your badge

Photo: Marcus Kim, RN, Fitness enthusiast, Leukemia survivor

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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
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.
How it works
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
  • 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
  • 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 Premium
  • 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 HDHP

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.

© 2023 Baylor Scott & White Health. All Rights Reserved.
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