The most you will have to pay in prescription copays is $12 per month. Some mental health drugs and most family planning drugs do not have a copay.
Specialty drugs are used to treat certain complicated health problems. These drugs tend to be very expensive and may need special handling and monitoring.
If you are prescribed a drug that is on our specialty drug list, your prescriber will need to send the prescription of that specialty drug to our preferred specialty pharmacy, Accredo Specialty Pharmacy.*
How to Fill a New Specialty Drug Prescription
Step 1: Check the specialty drug list, which shows all of the medications Medica considers specialty drugs.
Step 2: Your plan may not cover all of the drugs on the specialty drug list. To find out about your coverage for a specialty drug, please call Medica Member Services.
Step 3: Once you've verified your coverage, fill your prescription through Accredo Specialty Pharmacy.*
First time filling a prescription – Call Accredo to set up an account. Have your Medica ID card ready when you call.
Refilling an active prescription – Create an account on the Accredo Patient Portal to manage refills.
* There are a small number of drugs not available through Accredo Specialty Pharmacy. These drugs may be considered limited distribution by the manufacturer and must be obtained through a different specialty pharmacy. These drugs have a “*” next to them in Medica’s specialty drug list.
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 will not be covered and you will be responsible for the entire cost.
Some drugs need approval or prior authorization before you get your prescription filled. Your healthcare provider can request prior authorization approval from Medica. You must get approval from Medica before you can fill your prescription for these drugs or Medica may not cover the cost.
It is important for your healthcare provider to fill the form out as completely as possible and list which medications have been tried and failed. Please include the dosages that were used and the reason why the drugs didn't work (e.g., side effects or effectiveness).
American Indians can continue to use tribal and Indian Health Services (IHS) clinics. We will not require prior approval or impose any conditions for you to get services at these clinics. For elders age 65 years and older this includes Elderly Waiver (EW) services accessed through the tribe. If a doctor or other provider in a tribal or IHS clinic refers you to a provider in our network, we will not require you to see your primary care provider prior to the referral.