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Information applicable to Minnesota Health Care Programs members

Pharmacy Resources

2019

Covered Drug Lists (Formularies)

Please note that the Medica aligns with the drugs listed on the current DHS list of Preferred and Non-Preferred drugs, however there may be differences on the utilization management that applies to them, such as Prior Authorization, or quantity limits. Please see the Medica formulary section of the DHS PDL for those details.

Frequently Asked Questions (FAQs) for Providers Regarding the Uniform Preferred Drug List


Prior Authorization (PA) Requests and Formulary Exceptions

Medication Request and Exception Forms

Minnesota Health Care Programs Prior Authorization Inquiries

Phone: 1-877-433-7643

Fax: 1-866-255-7569

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 >

Please check back in November 2019, to review the 2020 drug list (formulary).

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 Minnesota Health Care Programs Specialty Drug List (PDF)

 

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: 11/19/2019 3:33:03 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CMSWEB01