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Pharmacies and Prescriptions

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Medica DUAL Solution

Pharmacy Benefits

Your plan includes pharmacy benefits that cover certain:

  • Drugs covered by Medical Assistance
  • Drugs covered by Medicare Part B or Part D
  • Over-the-Counter drugs
  • Medication Therapy Management services

List of Covered Drugs (Formulary) – (PDF)

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 in the Benefits and Coverage section.

Part D Covered Drugs

The following is the comprehensive List of Covered Drugs (Formulary) that includes drugs covered by Medicare Part B and Part D, 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)

Need Help with Paying for Part D?

You may be able to get extra help paying for your prescription drug premiums and costs. See our Low-Income Subsidy (LIS) summary table for potential rates.

LIS monthly premiums


Drug Exceptions

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

Medica DUAL Solution Prior Authorization Coverage Determination Request FormOnline | PDF

Appeals and Denials

If your Prior Authorization request for coverage of a prescription drug was denied and you want to appeal the decision, please fill out the form below.

Medica DUAL Solution Coverage Redetermination Request Form: Online | PDF

Transition of Care

If your drug isn't on our List of Covered Drugs (Formulary), or if it has certain restrictions, you may be able to request coverage for a transition period.

Transition of Care Policy (PDF)

Find a Pharmacy

Use these tools to find a network pharmacy near you.

View the online searchable pharmacy directory

View the Provider and Pharmacy Directory (PDF)

Register for Mail Order Pharmacy

Your plan includes the option of having prescriptions filled through the mail.

How to use mail order

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). 

Find out about MTM

Medica DUAL Solution is a health plan that contracts with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. Enrollment in Medica DUAL Solution depends on contract renewal. 

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.

H2458_55531 Approved
Last Updated: December 2019

Date: 8/4/2020 11:48:18 AM Version: 4.0.30319.42000 Machine Name: PWIM4-CDWEB01