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Pharmacy Benefits

Prescription and over-the-counter (OTC) drug benefits

Your benefits include a wide range of prescriptions and over-the-counter (OTC) medicines. We work with MedImpact to provide these pharmacy benefits.

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Prescription drugs
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OTC drugs with a written prescription
 

Find a pharmacy

To find a pharmacy near you, use our pharmacy locator tool.

Find a pharmacy

Fill a prescription

Bring your member ID card and prescription to a plan pharmacy. A doctor can also call in the prescription for you.

It’s good to use the same pharmacy each time you fill a prescription. This way, your pharmacist will know about problems that may happen when you’re taking more than one prescription. If you use another pharmacy, you should tell the pharmacist about all medicines you are taking.

You can also get other services at MedImpact pharmacies. Don’t wait for an office visit — get these shots and services at the drugstore::

  • Flu vaccine
  • COVID-19 vaccine
  • COVID-19 testing
  • Tdap: tetanus, diphtheria, pertussis vaccine
  • Gardasil: human papillomavirus vaccine
  • Pneumovax 23 and Prevnar 13: pneumococcal pneumonia vaccines
  • Zostavax: shingles vaccine

Dose Optimization

The Dose Optimization program can help you follow your medicine routine. You, your prescribing doctor, and a pharmacist work together to replace many doses of lower-strength drugs with one dose of a higher-strength drug. Your prescribing doctor has to approve this change to make sure it’s right for your care.

Preferred Drug List (PDL)

The Preferred Drug List (PDL) is the list of drugs that your doctor will use first when prescribing you medicine. These drugs have been chosen for their quality and effectiveness. Your doctor can prescribe most of these medicines to you without getting preapproval, or an “OK,” from us. The PDL is updated often.

Searchable formulary

The formulary is a list of all brand-name and generic drugs available in your plan. It lists all the drugs found on the PDL, plus others. All drugs on the formulary are covered, but many require preapproval before the prescription can be filled.

Find your medicine

Do you want to look up your medicine and find out if it is covered in your plan? It’s easy when you use our search tool. This tool will help you learn about any limitations or restrictions for any particular drug.

You can search for your drug by typing the name (at least first three letters) of the drug in the search box.

Search the formulary

Prior authorizations (preapprovals)

Some medicines need a preapproval, or an “OK,” from MedImpact before your doctor can order them. The preapproval process helps us make sure that you’re taking drugs safely and the right way.

Here are some reasons that preapproval may be needed:

  • There is a generic or pharmacy alternative drug on hand.
  • It is for a greater amount of medicine than our standard 30-day supply.
  • The drug could be misused or abused.
  • There are other drugs that should be tried first.
  • The drug has a high side effect that could happen.
  • The drug is prescribed at a higher dose than recommended.
  • There is more information needed about your health issue so we can match it to the FDA approval of the drug and/or studies of effectiveness.

For medicines that need preapproval, your doctor will need to call 844-336-2676 Monday through Friday from 8 a.m.-7 p.m. MedImpact will review the request and give a decision within 24 hours. If you need your medicine right away, you may be able to get a 72-hour supply while you wait.

Need help?

If you misplace your medicine or it is stolen, talk to your doctor. They will work with the pharmacy and MedImpact to review your case and replace the medicines as needed.

If you have any questions about your pharmacy benefit, call 800-210-7628 24 hours a day, seven days a week.

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Get your specialty medications

If you have a complex or chronic health condition that requires special medicine, we can help. We partner with IngenioRx Specialty Pharmacy and other pharmacies to meet all your specialty medication needs.

Learn about specialty pharmacy