Skip to Main Content

Pharmacies and Prescriptions

« Return to previous page

2016 Pharmacy Benefits

Covered drugs are shown on the Medica Preferred 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 Preferred 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.

Estimate Drug Costs  View Preferred Drug List

2017 Pharmacy Benefits

We're making changes to our pharmacy program Jan. 1, 2017. This change will help keep health care costs as low as possible for everyone, while continuing to make sure you have access to safe, affordable and effective prescriptions.

Find 2017 pharmacy benefit information »

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 Fairview 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. Talk to your doctor to make sure it's OK to order a 90-day supply of your medication — mail order drugs can't be returned.
  3. 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 mymedica.com.


How to Sign Up

You can sign up for Fairview Mail Service Pharmacy by phone or mail. Allow up to 10 business days for your order to arrive.

To sign up by phone, call Fairview at 866-377-6245 (toll-free) Monday through Friday, 8 a.m. to 7 p.m. CST, or Saturday, 8 a.m. to 4 p.m. CST. TTY users call 711. Have your Medica ID card ready.

If you don't want to register by phone, you can sign up by mail. Visit Fairview Mail Service Pharmacy online and follow the instructions to get started. 



Keep Your Information Current

If you move or need to change your delivery address (e.g., if you head South for the winter), let Fairview know by calling the number above at least 10 days before your next refill.

If any of your other account information changes —  payment details, insurance information, health conditions, etc. — be sure to call Fairview to let them know. Any information you provide Fairview 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 Fairview Specialty Pharmacy to fill your prescriptions.

View the specialty drug list »

If you need a specialty drug:

  • Check the specialty drug list, which shows all of the medications Medica considers specialty drugs.
  • 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. 
  • Once you've verified your benefits, have your prescription filled through Fairview Specialty Pharmacy*.

Note: If you fill your specialty drug prescription through a vendor other than Fairview Specialty Pharmacy*, your drug will not be covered and you will be responsible for the entire cost. 

Fairview Specialty Pharmacy
Phone: 612-672-5288 or 877-509-5114 (toll-free)
Fax: 866-347-4939

Learn more at Fairview Specialty Pharmacy »


*Or through an appropriate venue 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 Fairview Specialty Pharmacy to fill your prescriptions.

View the 2017 specialty drug list »

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 Provider Customer Service at 800-788-2949 or by faxing a completed Exception Request 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.

Find a Pharmacy

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

Search the online directory »

 


 

Date: 4/30/2017 11:50:03 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CMSWEB01