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Medications your plan covers

Medications your plan covers

Prescription medications

 

We cover the prescription medications on the preferred drug list (PDL). These medications need to be medically necessary. This means you need them to manage a health condition.

 

You can check the downloadable PDL (PDF). Or check it using our online search tool. If your medication isn’t on this list, ask your provider to prescribe a similar one that's on the PDL.

 

The state updates the PDL regularly. Updates may include info about the addition and/or removal of:

 

  • A medicine from the PDL
  • Quantity limits
  • Prior authorization (PA) requirements

You can find the most up-to-date PDL using our online search tool.

 

 

Diabetes prescriptions

If you need a prescription for glucose meter and test strips, Johnson & Johnson OneTouch® products are preferred. The preferred pen needles and insulin syringes are BD products.

 

Need PA? Just ask your provider to complete PA. Or they can call Provider Experience at 1-855-221-5656 (TTY: 711).

 

PDL (PDF) Online search tool

 

Still not sure if we cover your medication? Just call 1-855-221-5656 (TTY: 711). When you call, have a list of your prescription medications ready. We can check them for you.

 

Understand your medication

 

Be sure to tell your providers about all the medications you take. This includes over-the-counter medications, vitamins and supplements. Understand what your medication is for and how to take it. Check out these medication tips. Or find answers to your questions in our pharmacy FAQs (frequently asked questions).

 

Pharmacy FAQs

 

OTC medications

 

You can get coverage for some OTC medications on the PDL when you:

 

  • Meet any added requirements (for some medications)
  • Get a prescription from your provider
  • Fill your OTC prescription at a pharmacy in our network

 

Still not sure if we cover your medication? Just call 1-855-221-5656 (TTY: 711). When you call, have a list of your OTC medications ready. We can check them for you.

 

$25 for OTC products

 

As well as standard coverage for some OTC products on the PDL, we added another OTC benefit for you. Enjoy $25 per month (per household) toward some OTC medications and supplies. We’ll mail them directly to you. Just have your member ID number ready when you place your order:

 

En línea: Just sign in with your member ID and password. Or create a new account if you’re a first-time visitor.

 

Por teléfono: You can call OTC Health Solutions at 1-888-628-2770 Monday through Friday, 9 AM to 8 PM CT.

 

By fax: Fax your completed form to 1-866-682-6733

 

Por correo en: Mail your form to the address on the form.

 

Store list for OTC benefit (PDF)

Get medications and refills

Get medications and refills

If you need medication, your provider will write you a prescription for one on the PDL. You’ll want to:

 

  • Ask your provider to make sure the medication is on the PDL
  • Take your prescription to a pharmacy in our network
  • Show your plan member ID card at the pharmacy

 

Need refills? Your medication label notes how many refills you have. Call your pharmacy to place a refill order well before you run out of medication. If your prescription is out of refills, check with your provider at least five days before you run out of medication. They may want to see you before adding refills.

Fill your prescriptions

 

In person

 

You can fill your prescriptions at any pharmacy in our network. We can’t cover medications that you fill at other pharmacies.

 

Find a pharmacy near me

 

By mail

 

Do you take medication regularly for a chronic (long-term) condition? If yes, you may be able to get medication by mail. Read on to learn more about starting mail service.

 

Get started with mail service

 

You can sign up for mail service:

Online

Log in to your Member Portal. Go to “Tasks” and then “Pharmacy Services.” Go to Caremark.com by clicking on the “CVS” link. Then, choose “start mail service” to print the mail-order form.

By phone

Just call CVS Caremark® at 1-855-271-6603 (TTY: 1-800-231-4403). You can call 24 hours a day, 7 days a week. If you say it’s okay, they’ll call your provider to get a prescription. 

With an order form 

Ask your provider to write a prescription for a 90-day supply with up to one year of refills. Then, fill out a mail service order form — English (PDF) | Spanish (PDF).

Send the form, along with your prescription, to:    


CVS Caremark   
PO Box 2110    
Pittsburgh, PA 15230-2110   

Medicamentos de especialidad

Medicamentos de especialidad

Do you have a prescription for a specialty medication? If yes, you can fill it at any pharmacy in our network. Not all pharmacies carry these medications. So you may need to find a specialty pharmacy. 

 

Your provider may need to get PA for some medications. 

Medication recalls

 

Need info about medication recalls? Just call the U.S. Food and Drug Administration (FDA) at 1-888-463-6332.

 

Medication recalls

 

Pharmacy access and rules

 

What is the Pharmacy Lock-in program?

 

This program helps to prevent potential abuse or misuse of medical or pharmacy benefits. Members choose one in-network pharmacy to fill prescriptions and stick with it. 

 

What happens if my pharmacy doesn’t have the medicine I need?

 

You’ll be able to get a 72-hour supply of medicine from a different pharmacy. You can also do this in an emergency. 

  

What if I don’t want to use only one pharmacy?   

 

You can file an appeal. To learn more about how to file an appeal, just visit our grievances and appeals page. 

Contáctenos

Questions? Just call Member Services at 1-855-221-5656 (TTY: 711). We’re here for you 24 hours a day, 7 days a week.

One Touch is a trademark of LifeScan IP Holdings, LLC.

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