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Pharmacies and Prescriptions

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Pharmacy Benefits

Medica pharmacy management services help our members achieve:

  • Effective use of medications through appropriate prescribing and patient awareness
  • Convenient access to quality prescription drugs
  • The highest level of cost savings

Use the Price a Medication tool to easily search by drug name or the general therapeutic category to compare multiple drugs available for a particular condition.

The drug costs presented are an estimate of copay and plan sponsor costs based on common pharmacy plan designs. This allows a member to compare the potential costs of various prescription medications. A member's actual drug costs will be determined when they fill a prescription using their selected Medica plan.

Members with certain plans in select states will pay no more than $25 for insulin per prescription unit. For plans that normally have a deductive for prescriptions, the deductible will be waived for insulin.

Estimate drug costs >

Drug List

To ensure safe, effective and economical drug therapy, Medica uses a drug list. This is a list of covered generic and brand-name medications selected for safety, quality standards, effectiveness and cost.

The list contains both brand-name and generic drugs with proven safety and effectiveness, and is reviewed and updated regularly by the Pharmacy and Therapeutics Committee — an independent committee comprised of practicing physicians and pharmacists.

  • Drugs may be added to the list upon review at anytime during the year. Medica strives to not remove medications from the drug list more than twice each year. 
  • If a generic alternative becomes available for a brand-name medication on the drug list, the list may be updated to include the generic as the preferred drug.
  • Medications on the drug list are divided into groups. These groups determine a member's out-of-pocket costs.

A doctor can also use the drug list to choose medications for a member's health care needs, while helping the member get the most value from their prescription drug benefit.



Drug Programs

Medica has several drug programs to help members cost effectively manage prescriptions drugs.

Step Therapy

Step Therapy is a program focused on members receiving appropriate and affordable drug treatments. This program is used for conditions with many treatment options and requires members to receive preferred drugs (Step 1 drugs) as the first line of therapy.

Step 1 drugs are effective, but more affordable. When appropriate, a more costly (Step 2) medication can be authorized if the Step 1 prescription is not effective in treating the condition.

Conditions that can be treated using many safe, effective medications may be eligible for the Step Therapy program. All Step Therapy programs have been reviewed and approved by our Pharmacy and Therapeutics Committee, a panel of independent practicing physicians and pharmacists.

Specialty Drugs and Specialty Drug List

Specialty drugs are high-technology, high cost, oral or injectable drugs used for the treatment of certain diseases that require complex therapies. Many specialty drugs require special handling and in most cases are prescribed by a specialist.

Our designated specialty pharmacy allows members the convenience of home delivery, or the option to pick up most prescriptions at one of their local sites. Members will be provided with resources and support to help them achieve the best results from prescribed therapy.

An experienced care team of pharmacists and nurses is available to help members obtain medication, answer questions, assist in managing side effects, and lend overall support.

Note: Members should refer to their coverage documents to determine their specific benefit levels for specialty drugs. If a member has questions about their specialty drug coverage, they should call the Medica Customer Service number on the back of their ID card.

2021 Specialty Drug List (PDF)

Specialty Drug Vendor

Accredo Specialty Pharmacy is our preferred Specialty Drug Program vendor.

Accredo Customer Service representatives are available Monday through Friday, 7 a.m.–10 p.m. and Saturday 7 a.m.–4 p.m., Central
Phone: 1-866-544-6817 (toll-free)

90-Day Refill Options

Obtaining a 90-day prescription supply is not only convenient, but can result in cost savings for many members, particularly those taking brand-name medications. Those taking generics should also investigate their options since many retail pharmacies will also offer discounts for a 90-day supply of generic medications.

Members who take maintenance medications may receive up to a 90-day supply from a participating pharmacy by paying three copays at once.

Use our online directory to find a participation pharmacy.

Pharmacy locator

Mail Order Program

Members may receive a 90-day supply of medications delivered to their home. Prescriptions can be ordered via mail, phone or online from Express Scripts® Pharmacy. For fully insured customers with a copay plan, members can receive a 90-day supply for only two copayments.

Frequently Asked Questions

These are questions frequently asked by our members

A brand-name drug is protected by a patent for a certain amount of time. That means only one manufacturer can make the drug during that time. Once the patent expires, generic versions of the drug are often introduced.

Generic drugs have the same active ingredients as their brand-name counterpart and must meet the same quality standards as brand-name drugs, but are generally less expensive.

Both brand-name and generic drugs are regulated by the Food and Drug Administration (FDA).

Yes. A team of physicians and pharmacists regularly reviews new and existing drugs to be sure the drug list continues to meet the needs of our members and providers. Drugs may be added to the list at any time during the year; however, Medica strives to limit removing drugs to no more than twice a year.

If a generic equivalent becomes available for a brand-name medication on our drug list, we may update the list to only include the generic as the preferred drug. If a change to the list affects a drug you are taking, we’ll send you a letter telling you about the change.

A quantity limit is a maximum amount of a drug that is allowed to be filled during a specific period of time. For example, 60 tablets per month. Drugs that have a quantity limit are noted on the drug list.

Specialty drugs are used to treat certain complex health problems. These drugs tend to be very expensive and may need special handling and monitoring. For most specialty medications, you'll use Accredo Specialty Pharmacy to fill your prescriptions.*

2020 specialty drug list (PDF)

*Or through the designated specialty pharmacy vendor if it's a limited distribution drug.

Step Therapy is a program focused on using cost-effective prescription drugs as first-line treatment when appropriate. The program is used for certain conditions where there are many treatment options available. Drugs that require Step Therapy are noted on the drug list.

In Step Therapy, you try the Step 1 preferred drug or drugs first. Step 1 drugs are cost efficient and effective options. If the Step 1 drug isn’t effective, you can then try the Step 2 drug. In some cases, you may need to try more than one Step 1 drug before trying a Step 2 drug.

Step Therapy applies to all members, regardless of their plan type. That means that if you don’t try the Step 1 drug or drugs first, then a Step 2 drug won’t be covered. Your doctor can request an exception to this process.

Prior Authorization is approval given by Medica for coverage of a certain medication. Medications that require Prior Authorization are noted on the drug list with a "PA" next to the drug name. As a provider in the Medica network, your doctor will know how to request Prior Authorization.

Find a Pharmacy

Use our online directory to find a network pharmacy near you.

Pharmacy locator

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