Skip to Main Content

Pharmacies and Prescriptions

« Return to previous page

Member Through Work

Pharmacy Benefits

Your plan includes coverage of prescription drugs and a range of options for filing your prescriptions. Covered drugs are shown on the Medica drug list, which is comprised of drugs that provide the most value and have proven safety and effectiveness. This helps keep your share of the costs at their lowest. 

Explore the tabs below to see how to access the drug list, learn about options for filling your prescriptions, find information about specialty drugs and get answers to frequently asked questions, including whether you need approval for a particular prescription or whether there are any limits on a particular drug.

Drug List

Access your plan’s drug list by logging on to your member portal at mymedica.com. You can see what drugs are covered and get an estimate for how much they’ll cost. After you log in, select the "Pharmacies and Prescriptions" tab and then click on the "see what drugs are covered and compare prices at local pharmacies" link to begin your search.



Medica's Drug List includes OneTouch Verio® diabetes testing supplies.
Receive a OneTouch Verio® blood glucose meter from CVS at no cost to you (PDF).  
When you need testing supplies, ask your doctor to write you a prescription for OneTouch test strips, lancets and control solution. 

Mail Order Pharmacy

If you have prescriptions for a long-term condition and your pharmacy benefit includes mail order, getting your drugs through the mail may be a convenient option for you.   

Medica offers pharmacy mail order through CVS Caremark Mail Service Pharmacy. You'll receive a 90-day supply of your medication through the mail, with no shipping or handling fees.

Before Signing Up for Mail Order

  1. Verify that your pharmacy benefit includes mail order. You can check your coverage document, available on mymedica.com, or call Customer Service at the number on the back of your Medica ID card.
  2. Register on the CVS Caremark website through your portal at mymedica.com.
  3. Talk with your doctor to make sure it’s OK to order a 90-day supply of your medication.
  4. Check pricing at your retail pharmacy. Depending on your benefits, you may find that it’s less expensive to continue getting your medications at your local pharmacy. You can compare costs using the "Check Drug Cost" tool on the CVS Caremark website (access the CVS Caremark website through your member portal at mymedica.com).

How to Fill Mail Order Prescriptions

You can easily request prescription fills using the CVS Caremark website (accessible through mymedica.com), using the CVS Caremark mobile app or by calling CVS Caremark Mail Service Pharmacy. CVS Caremark Mail Service Pharmacy representatives are available 24 hours a day, seven days a week at 1-844-453-5186 (TTY users, dial 711). Have your Medica ID card ready. You also have the option to complete and submit the Mail Service Order Form below.

Allow up to 10 business days for your order to arrive.

Mail Service Order Form (PDF)


Keep Your Information Current

If you move or need to change your delivery address (e.g., if you head south for the winter), let CVS Mail Service Pharmacy know by calling the number above at least 10 days before your next refill. If any of your other account information changes — for example, payment details, insurance information, health conditions, etc. — be sure to call CVS Mail Service Pharmacy to let them know. Any information you provide CVS Mail Service Pharmacy is kept confidential and secure in accordance with national and state privacy laws.

90-Day Refill Option

For ongoing medications, you can get up to a 90-day supply at one time from a participating pharmacy. You'll pay three retail copayments or coinsurance amounts (depending on your plan) and get the convenience of saving trips to the pharmacy.

How it Works

For a new prescription:

  1. Ask your doctor for up to a 30-day supply of the medication on one prescription. This lets you first try the drug to make sure the dose and drug work for you.
  2. Also ask for a second prescription for up to a 90-day supply of the same medication. You can fill this once you and your doctor know that the medication is right for you. Just bring the prescription to a participating Retail 90 pharmacy and present your Medica ID card.
  3. Your pharmacist will fill the prescription and you'll pay the amount you owe.

For refills:

  1. Ask your doctor to write a prescription with refills for up to a 90-day supply of your medication.
  2. Bring the prescription to a participating Retail 90 pharmacy and present your Medica ID card.
  3. Your pharmacist will fill the prescription and you'll pay the amount you owe.

Find a Retail 90 pharmacy

For more information about Retail 90, call Medica Customer Service at the number on the back of your ID card.



Specialty Drugs

Specialty drugs are used to treat certain complicated 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, our preferred Specialty Drug Program vendor as of 1/1/2018, to fill your prescriptions. There are a small number of drugs not available through Accredo Specialty Pharmacy. Discuss your options about these limited distribution drugs with your prescriber.

2018 specialty drug list (PDF)

If you need to fill a new specialty drug:

  1. Check the specialty drug list, which shows all of the medications Medica considers specialty drugs.
  2. Your plan may not cover all of the drugs on the specialty drug list, so check your coverage document on mymedica.com, or call the Customer Service number on the back of your Medica ID card for your specific benefits. 
  3. Once you've verified your benefits, have your prescription filled through Accredo Specialty Pharmacy*.

Note: 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. 

How to refill your prescription with Accredo Specialty Pharmacy:

After your first fill, you can create an account on the Accredo Patient Portal to view and manage your refills. You will need an active Accredo prescription number to register on the portal.

Access Accredo Patient Portal

You can also request a refill by calling the number below.

Accredo Specialty Pharmacy
Phone: 1-866-544-6817 (toll-free) (TTY/TDD users dial 711)
Accredo Customer Service representatives will be available Monday through Friday 7 a.m. – 10 p.m. and Saturday 7 a.m. – 4 p.m. Central.

Do you use a drug manufacturer savings card to help pay for your specialty drug? If yes, learn about a change starting January 1, 2018, which may impact you.

Learn about drug manufacturer savings card changes

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

 


Frequently Asked Questions

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.*

2018 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.

Your doctor can request an exception to the drug list by calling the CVS Pharmacist Help Desk at 800-364-6331 or by faxing a completed prescription drug prior authorization (PA) requests and formulary exception form..

Your doctor should provide all the requested information, including which medications have been tried and didn't work (i.e., dosage information and reason for failure, such as side effects lack of efficacy, etc.).

Yes. If your exception request is denied, Medica will send you a letter explaining your right to appeal and the process for the appeal. You can also call Medica Customer Service at the number on the back of your ID card and tell the representative that you wish to appeal a decision.

Medica's Drug List includes OneTouch Verio® diabetes testing supplies.

Receive a OneTouch Verio® blood glucose meter from CVS at no cost to you (PDF).  

When you need testing supplies, ask your doctor to write you a prescription for OneTouch test strips, lancets and control solution. 

Find a Pharmacy

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

Pharmacy locator

 


 

Date: 7/21/2018 5:58:26 PM Version: 4.0.30319.42000 Machine Name: PWIVE-CMSWEB02