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Individual & Family

Pharmacy Overview for Providers Home > Individual and Family 

Information applicable to Individual and Family members

Pharmacy Resources

2020

We’re making important changes to our pharmacy program for 2020. We've created a special website to help assist you and your patients through our Jan. 1 pharmacy benefit manager transition.

View pharmacy program changes >


Drug Lists

2020 Drug List for Plans in KS (PDF)

2020 Drug List for Plans in IA, WI (PDF)

2020 Drug List for Plans in MN, MO, ND, NE, OK (PDF)


Prior Authorization (PA) Requests and Formulary Exceptions

2020 Prior Authorization Requests and Formulary Exceptions »

NOTE: Prior authorization and formulary exception requests may be submitted to Express Scripts® for review starting January 1, 2020.

Specialty Drug Program

Medica relies on preferred vendors to manage specialty drugs for members. As of 1/1/2018, Accredo Specialty Pharmacy is our preferred Specialty Drug Program vendor.

Members who have questions about their specialty drug coverage should call the Customer Service number listed on the back of their Medica ID card.

For access to specialty drug referral forms, visit Accredo Specialty Pharmacy’s referral form page, or call Accredo Specialty Pharmacy at 1-866-544-6817.

Specialty Drug Lists

2019 Individual and Family Specialty Drug List (PDF)
2020 Individual and Family Specialty Drug List (PDF)

Mail Order Pharmacy 

Medica offers prescription mail order through CVS Caremark Mail Service Pharmacy. With a 90-day prescription, members may receive a 90-day supply of their medication through the mail with no shipping or handling fees. Commercial and Individual and Family plan members can request prescription fills using the CVS Caremark website, using the CVS Caremark mobile app or by calling CVS Caremark Mail Service Pharmacy at 1-844-453-5186. These actions will initiate a quick start process allowing CVS Caremark Mail Service Pharmacy to work directly with the member’s prescriber. Prescribers may fax (1-800-378-0323) or e-prescribe (CVS Caremark Mail Service Pharmacy, NCPDP ID: 0322038, 9501 E Shea Blvd., Scottsdale, AZ 85260) prescriptions for their patients.

PLEASE NOTE: Starting January 1, 2020, Medica will transition to Express Scripts PharmacySM for prescription mail services. Members will be able to continue receiving a 90-day supply of their long-term drugs through the mail with no shipping or handling fees.

Diabetic Meters

Accu-Chek® blood glucose meters and testing supplies are on Medica's formulary as the preferred option. Members have access to one of the listed Accu-Chek blood glucose meters at no extra cost:

  • Accu-Chek Guide
  • Accu-Chek Aviva Plus
  • Accu-Chek Nano

Members can receive a new preferred meter by:

  • Calling CVS Caremark toll-free at 1-800-588-4456, Monday through Friday from 8 a.m. and 6 p.m. Central time
  • Downloading, completing and submitting a Diabetic Supply Order Form (PDF)


Date: 11/18/2019 7:35:10 PM Version: 4.0.30319.42000 Machine Name: PWIVE-CMSWEB02