Medicare Part D: The Medicare prescription drug benefit program. We call this program “Part D” for short. Medicare Part D covers outpatient prescription drugs, vaccines, and some supplies not covered by Medicare Part A or Medicare Part B or Medical Assistance. Our plan includes Medicare Part D.Medicare Part A: The Medicare program that covers most medically necessary hospital, skilled nursing facility, home health, and hospice care.
Medicare Part B: The Medicare program that covers services (such as lab tests, surgeries, and doctor visits) and supplies (such as wheelchairs and walkers) that are medically necessary to treat a disease or condition. Medicare Part B also covers many preventive and screening services.Medical Assistance: This is the name of Minnesota’s Medicaid program. Medical Assistance is run by the state and is paid for by the state and the federal government. It helps people with limited incomes and resources pay for long-term services and supports and medical costs.
It covers extra services and some drugs not covered by Medicare. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

Prescription drug coverage

South Country covers a wide variety of prescription drugs in our formulary. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. These rules may include restrictions like requiring a prior authorization for a drug before we will cover it. For more information about your prescription drugs and our plan rules, please review your member handbook or the drug list (use the dropdown menu on the right to see the materials).

Formulary medications are FDA-approved and have been chosen for their reported medical effectiveness and value. The formulary is updated monthly, and the list of drugs may change.

For 2025, all Part D drug copays will be $0.

Certain drugs are not covered through Medicare Part D. When a drug is not covered under Medicare Part D, in many cases it may be covered by Medical Assistance. These drugs may be labeled as over-the-counter or "OTC" drugs in the List of Covered Drugs. There is no copay for Medical Assistance-covered drugs.

South Country has a Prescription Drug Transition Policy (pdf) (12/30/24) which explains what happens in certain situations, like when join us from another health plan, or if treatments settings change because of level of care changes.

What if my drug is not in the formulary?

First, contact Member Services and ask if your drug is covered. If Member Services tells you that South Country Health Alliance does not cover your drug, you have two options:

  • Your doctor or pharmacy can call the PerformRx Provider Help Desk to discuss options that are covered by South Country Health Alliance. The Provider Help Desk number is on the back of your ID card.
  • You can ask South Country Health Alliance to make an exception and cover your drug. For more information on how to request an exception, go to our Coverage Decisions and Complaints page.

More information for different parts of our prescription drug coverage.

More Information

SeniorCare Complete and AbilityCare are health plans that contract with both Medicare and the Minnesota Medical Assistance Program to provide benefits of both programs to enrollees. Enrollment in either plan depends on contract renewal.

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