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Pharmacies and Prescriptions

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Medica ChoiceCare MSC+

Pharmacy Benefits

Your plan includes pharmacy benefits that cover certain:

  • Drugs covered by Medical Assistance
  • Over-the-Counter drugs
  • Medication Therapy Management services (if you do not have Medicare Part D benefits)

List of covered drugs (PDF)

How To Fill A Prescription

Copay Information

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.

Type of Drug  Copay Amount
Brand-name drugs $3
Generic drugs  $1


Covered Drugs

To find out if a drug is covered, select from the lists below. For drug limitations and exceptions, refer to your Member Handbook.

List of Covered Drugs

The following is the comprehensive List of Covered Drugs (Formulary) that includes drugs covered by Medical Assistance and Over-the-Counter drugs. To receive a covered drug, you need to have your health care provider write a prescription for it and then you can take the prescription to a pharmacy in the Medica network. The pharmacist will give you a generic version of the drug if one is available.

2020 List of Covered Drugs (Formulary) – (PDF)



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. If you are prescribed a drug that is on Medica’s Specialty Drug List, your prescriber will need to send the prescription of that specialty drug to Medica’s preferred specialty pharmacy, Accredo Specialty Pharmacy.

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 at the number below and they can let you know which specialty pharmacies can dispense the drug you need.

View the 2020 Minnesota Health Care Programs 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. If you have questions about your coverage for a specialty drug, please call Medica Member Service at the number on the back of your Medica identification card.
  3. Once you've verified your coverage, have your prescription filled through Accredo Specialty Pharmacy*. You will need to call the specialty pharmacy at the number below to set up an account. You will need to refer to your Medica identification card when you call the 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 Accredo’s Patient Portal to view and manage your refills. You will need an active Accredo prescription number to register on the portal. You can access the portal by visiting medica.com/AccredoSpecialtyRx. You can also request a refill by calling the number below.

Accredo Specialty Pharmacy Customer Services

Toll free: 1-866-544-6817 (toll-free) (TTY: 711)
7 a.m. – 10 p.m. Central, Monday – Friday
7 a.m. – 4 p.m. Central, Saturday.

Fax: 1-877-329-4605

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

 


Drug Exceptions

Some drugs need approval or Prior Authorization before you get your prescription filled. You or 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.

Prior Authorization

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 (i.e. side effects or effectiveness).

Minnesota Uniform Form for Prescription Drug Prior Authorization (PA) Requests and Formulary Exceptions



Review Your Medications

Talk to a pharmacist and learn how to get the safest and most effective results from your drugs with Medication Therapy Management (MTM). 

Learn about MTM

Do You Have a Medicare Plan?

If you have Medicare, you must get most of your prescription drugs through the Medicare Prescription Drug Program (Medicare Part D). Your Part D plan will pay for most of your prescription drugs. You may have a copay.



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.

Last updated: December 2019


 

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