At Medica HealthCare Plans, we provide our members with an extensive formulary. There may be instances when you need a drug that is not covered in our plan, or the restrictions on a drug may not meet your needs. To ensure you receive optimum care, we provide you with the following options when your prescription is not covered:
Contact Member Services to confirm that the medication is not covered.
Ask your doctor if you can switch to another drug that we cover.
Contact Member Services if you would like to provide your doctor with a list of covered drugs used to treat similar medical conditions.
Ask us to make an exception to cover your drug using the Coverage Determination Request Form.
Pay out-of-pocket for the drug and then request an exception using the Coverage Determination Request Form.
If you are a new member, you may be able to get a temporary supply of a medication you were taking when you joined the plan. Check with Member Services to see if you qualify for this benefit.