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 Effective April 2018.
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.
1. Where do I get medications after November 1, 2017?
Our pharmacy network includes many pharmacies in your area. It is likely that your local pharmacy is in our network. A directory of contracted pharmacies is available on our website.If you are not sure if your pharmacy is in our network, call Member Services.
2. What if my pharmacy is not in the Health Choice Integrated Care network?
If your pharmacy is not in our network, you can transfer your prescriptions to a new pharmacy.
3. How do I transfer prescriptions to a pharmacy in the Health Choice Integrated Care network?
- Locate a pharmacy in our network:
- Visit our website and choose the Find a Doctor/Pharmacy tab or
- Contact Member Services, and we will find a pharmacy for you.
- Tell your new pharmacy that you want to have your prescriptions transferred. Give them the contact information for your current pharmacy. The new pharmacy will contact your current pharmacy and make the transfer.
4. Can I get my prescription drugs from a pharmacy that is not in the Health Choice Integrated Care network?
You should always go to a pharmacy in the Health Choice Integrated Care Network. A pharmacy that is not in our network cannot help you fill your prescription or help with your drug benefits.
If you use a pharmacy that is not in our network, you will have to pay the full cost of the drugs. Your drugs may not be eligible for reimbursement; this means you will not get paid back if you pay out of pocket for your medication.
5. How do I get refills for drugs I am currently taking after November 1, 2017? If your drugs needed prior authorization, Health Choice Integrated Care will honor the authorization until it expires.
In some cases, you may need to get a new prior authorization:
- Some drugs that did not previously require prior authorization may require it after November 1, 2017. If your drugs need prior authorization, you have sixty days to ask your doctor to submit a request. To find out if your drugs need prior authorization, you can:
- Visit the member section of the Health Choice Integrated Care website. Click on the Prescription Drugs tab and view the new formulary.
- Call Member Services, and we would be happy to help you.
- If your existing prior authorization expires, you will need a new authorization. You can ask your doctor to submit a new authorization request. You can call your pharmacy to find out when your authorization expires.
6. How can my local pharmacy join the Health Choice Integrated Care network?
If your pharmacy is not in the Health Choice Integrated Care network, please give us their name, address and phone number. We will contact them to see if they will join our network.
7. Will I get a new member ID card?
If you receive physical health benefits from Health Choice Integrated Care you will receive a new ID card from Health Choice Integrated Care. It is important that you bring your new ID card to the pharmacy to get your prescription drugs.
8. Will I have any co-pays?
(Follow guidelines in Member Handbook)
9. What if my medication comes from a Specialty Pharmacy?
If you currently receive your medication from EnvisionRX Specialty Pharmacy your pharmacy will change to BriovaRx. Your services will not be interrupted. (These medications are usually to treat complex medical conditions).
10. How do I find out if my drugs are covered?
Please refer to the Health Choice Integrated Care list of covered drugs, also called a formulary. You can find the list on our website. If you would like a printed copy, please call Member Services.
11. How will I know what drugs are covered with Health Choice Integrated Care by Behavioral Health?
Your pharmacy will tell you. You will still be able to get your drugs in the same visit. Your pharmacy will get approvals from Health Choice Integrated Care.
12. What is a formulary?
A formulary is a list of drugs that are safe and economical. An independent committee of doctors and pharmacists develops the Health Choice Integrated Care formulary. The independent committee reviews and updates the formulary regularly to include new drugs and treatments.
The formulary contains a wide range of drugs. The Food and Drug Administration (FDA) have approved all drugs on the formulary.
Health Choice Integrated Care covers all drugs listed in the formulary. Health Choice Integrated Care will not cover drugs not listed in the formulary.
13. What is the difference between a brand name and generic drug?
A brand name drug is protected by a patent. The patent protects the drug so that only one drug company can make it.
When the patent for a brand name drug ends, other drug companies can make a version of the drug. This is called a generic drug. A generic drug is a chemical copy of the brand name drug. The color or shape may be different, but the active ingredients are the same.
14. What is a prior authorization?
Some drugs require prior authorization. Specific criteria must be met before Health Choice Integrated Care can cover these drugs.
15. What happens if my drugs need prior authorization?
The pharmacist will find out if a drug requires prior authorization when the pharmacist submits your prescription for approval. Your pharmacist may submit the request for prior authorization at that time.
In some situations, your pharmacist may not have all the information to get the drug approved. When that happens, your doctor will contact Health Choice Integrated Care to request prior authorization.
Here is how you can view or search the Formulary:
- View or print a PDF of the HCIC Formulary Effective July 2018.
- To request a printed copy of the Formulary, HCIC’s customer service phone number is 1-800-640-2123. TTY/TDD users can call 711.
If you have questions about your filling your prescription, call our Pharmacy Help Desk at 1-877-923-1400, Option #2 or 928-774-7128, Option #2.
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.
- 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. You can also call our Pharmacy Help Desk at 1-877-923-1400, Option #2 or 928-774-7128, Option #2.