Pharmacy Benefits
The prescription drug benefit is managed by a Pharmacy Benefit Manager (PBM), Medco.
Certain prescription drugs require prior authorization. Please refer to the links below for detailed criteria that must be met before approval can be granted. Once you have read the criteria and you would like to initiate a drug coverage review, you will need to fax a drug coverage review form to the pharmacy benefit manager.
When you visit a participating pharmacy, present your ID card to the pharmacist. You will only be required to pay the appropriate copay for each 34-day supply:
- $10 for Generic drugs
- $25 for a Preferred Brand where no Generic option is available
- $40 for a Preferred Brand where a Generic option is available
- $50 for a Non-Preferred Brand
To better understand your pharmacy benefits, visit the State Health Plan website.
Complete list and approval forms for drugs that require prior approval.
If you need information on a medication that is not listed, please contact Medco, the State Health Plan's pharmacy benefit manager, at 1-800-336-5933 .
Your identification card serves as both a medical insurance and a prescription drug card.
