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Options for Drugs Not Covered

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: 

  • 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.