My prescriptions

The List of Covered Drugs (Formulary) includes prescription and over-the-counter drugs covered by Medicare Part B, Part D, and Medical Assistance.

To receive a covered drug:

• Have your doctor write a prescription for it
• Take the prescription to a pharmacy in your network

The pharmacist will fill your prescription with a generic version of the drug if available. If there's no generic version, the pharmacist will give you a name brand version.

$0 Part D

Your Medica DUAL Solution plan has no Part D cost sharing.

Some drugs need approval or Prior Authorization before you get your prescription filled. You or your health care provider can request prior authorization approval from us.

You must get approval from us before you can fill your prescription for these drugs or we may not cover the cost.

Prior authorization

It's important for your health care provider to fill the form out as completely as possible and list which medications have been tried and failed. Your provider should include the dosages that you used and the reason why the drugs didn't work (e.g. side effects or effectiveness).

Prior Authorization Coverage Determination Request Form

• Request for Prescription Drug Coverage Determination online form

• Request for Prescription Drug Coverage Determination paper form (PDF)

Appeals and denials

If your prior authorization request for coverage of a prescription drug was denied and you want to appeal the decision, please fill out the form below.

Coverage Redetermination Request Form

• Request for Redetermination of Medicare Prescription Drug Denial online form

• Request for Redetermination of Medicare Prescription Drug Denial paper form (PDF)

Specialty drugs are used to treat certain complex or chronic health problems. They tend to be very expensive and may need special handling and monitoring.

If you’re prescribed a specialty drug, your prescriber will need to send the prescription for it to our preferred specialty pharmacy, Accredo Specialty Pharmacy.*

How to fill a new specialty drug prescription

1. Check the List of Covered Drugs (Formulary), to see if your medication is a specialty drug.
2. Fill your prescription through Accredo Specialty Pharmacy.*
• First time filling a prescription: Call Accredo to set up an account. Have your Medica identification (ID) card ready when you call.
• Refilling an active prescription: Create an account on the Accredo Patient Portal to manage refills.

Accredo Patient Portal

Questions?

Accredo Specialty Pharmacy Customer Service

Toll-free: 1-866-544-6817     (TTY: 711)

7 a.m. – 10 p.m. CT, Monday – Friday
7 a.m. – 4 p.m. CT, Saturday

* There are a small number of drugs not available through Accredo Specialty Pharmacy. These drugs may be considered limited distribution by the manufacturer. This means you need to get them through a different specialty pharmacy.

Your provider typically knows where to send prescriptions for limited distribution drugs, but if you have any questions, contact Accredo Specialty Pharmacy.

If you fill your specialty drug prescription through a vendor other than Accredo Specialty Pharmacy*, your drug won’t be covered and you’ll be responsible for the entire cost.