Prescription Drug Information

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Your doctor may prescribe medication as part of your health care. It is important that you follow your doctor’s instructions and take the medication as your doctor has prescribed it.

View or print a PDF of the HCIC Medication Prior Authorization Criteria.

You must have your prescription filled by a HCIC participating pharmacy. Search the HCIC Provider Directory to find a participating pharmacy in your area.

HCIC provides a closed drug Formulary (medicine) benefit for its members. This means that if the drug is not in the HCIC Formulary, HCIC must first approve the prescription drug before you can purchase it at the pharmacy.

The HCIC Formulary is your guide to prescription drugs covered by HCIC. The Formulary is organized by sections. Each section includes therapeutic groups identified by either a drug class or disease state. Products are listed by generic name. Brand name products are included as a reference to assist in product recognition. Unless exceptions are noted, generally all dosage forms and strengths of the drug cited are covered. In addition, the formulary covers selected over-the-counter (OTC) products.

Here is how you can view or search the Formulary:

HCIC covers both brand name and generic drugs. Generic drugs have the same active ingredient formula as a brand name drug, but generic drugs usually cost less than brand name drugs. Generic drugs are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:

  • Prior Authorization: Health Choice Integrated Care may require prior authorization for certain drugs. You will need to get approval from HCIC for drugs noted with a “PA” in the drug list or for any drugs not listed in the formulary. If you do not get approval, Health Choice Integrated Care may not cover the cost of the drug.
  • Quantity Limits: For certain drugs, Health Choice Integrated Care may limit the amount of the drug that our plan will cover.
  • Step Therapy: In some cases, Health Choice Integrated Care requires a member to try certain drugs to treat a medical condition before covering another drug for that condition. For example, if Drug A and Drug B both treat the medical condition, Health Choice Integrated Care may not cover drug B unless you try Drug A first. If Drug A does not work for you, Health Choice Integrated will then cover Drug B.

You can ask HCIC to make an exception to these restrictions or limits. For more information about prescription drug restrictions or limits, call HCIC’s customer service phone number at 1-800-640-2123. TTY/TDD users can call 711.