Pharmacy Services
Access to Safe and Effective Medications
At Meridian, our goal is to provide the right drug coverage for our members. We work closely with doctors and pharmacists to make sure we offer medications that treat a range of conditions and illnesses. We are proud to work with partners who help us provide innovative and personalized pharmacy solutions. These partnerships help improve member health and make treatments more affordable. They ensure you have access to important medications. You also get support through personalized clinical programs.
How to find an in-network pharmacy
For no-cost medications, you have to visit a pharmacy in our network. Find one nearby using our Provider Finder tool. The prompts will ask for your location and what network you are in. Then choose the “Pharmacy & Medical Supplies” category.
Medication Coverage
How to get no-cost medications
We help you get the medications you need. In fact, there are no copays for covered or approved drugs filled at an in-network pharmacy.
The Preferred Drug List (PDL) is the list of drugs covered by Meridian. This list includes prescriptions and over-the-counter drugs used for treatment. Most are covered without a referral or medical review.
Other drugs require prior authorization (PA) from your doctor. Your provider will fill out a PA request form (PDF) if you need one. Our clinical staff reviews the request and lets you know if we can approve it.
Sometimes a drug on the PDL doesn’t work for you or makes you sick. Your provider can ask for a different drug via the PA request form (PDF). Once we approve the exception, you can get the prescription filled. Note: we cannot make any exceptions for drugs excluded by the State of Illinois.
We have a large network that lets members access many types of pharmacies. This includes retail, mail-order, and specialty pharmacies. This makes it easy for you to get your medications. We work closely with our pharmacy programs to make sure they meet your needs as a Meridian member.
Clinical Programs
Pharmacists identify drug therapy problems (DTPs) for members on 10 or more unique maintenance medications for 90 days or more. Provider outreach includes clear recommendations, like addressing therapy gaps and avoiding therapeutic duplication. This helps reduce overall medication use.
A targeted, system-generated review program that aims to identify clinically relevant drug therapy problems (DTPs) using pharmacy claims and medical diagnoses based on established logic. The system is capable of:
- Reviewing medication profiles to identify drug-related problems such as:
- Drug-drug interactions
- Duplicate therapy
- Excessive use or duration of therapy
- Inappropriate or suboptimal use
- Lack of therapy
- Sending faxes to providers with recommendations on resolving DTPs
- Generating letters to members with information on DTPs
- Tracking problems through to resolution
Pharmacists attempt to close unresolved DTPs every 90 days until the end of the year.
The polypharmacy program identifies members who are on eight or more maintenance medications per quarter and have at least one qualifying drug therapy problem (DTP) (drug-drug interaction, drug age interaction, opportunity to reduce cost, therapeutic duplication, excessive use, or issues related to fraud, waste, and abuse). The member's provider is sent a letter with recommendations on how to resolve the DTPs. A clinical pharmacist may also call the provider to ensure safe and effective use of medications through deprescribing.
If you have questions or problems with your prescription, call our Pharmacy Services team at 855-580-1688.
Fill and Receive Your Prescriptions
You can have your prescriptions filled at a network pharmacy. At the pharmacy, you will need to give the pharmacist your prescription and your Meridian ID Card.
Billing information:
RX BIN: 003858
RX PCN: MA
RX GROUP: 2EHA
To find a nearby in-network pharmacy, use our Provider Finder. You’ll be prompted to enter your location and network. Then choose the “Pharmacy & Medical Supplies” category. At the pharmacy, you will need to give the pharmacist your prescription and your Meridian ID Card.
Meridian offers a mail-order pharmacy service. It allows you to receive a 90-day supply of certain medications delivered to your door, saving time and money. Find a mail order pharmacy by using our Provider Finder tool. The prompts will ask for your location and what network you are in. Then choose the “Pharmacy & Medical Supplies” category.
Pharmacy FAQs
Be sure to take your Meridian member ID card to the pharmacy. And bring a personal ID, like a driver’s license or state issued ID, with your picture on it.
Fill out the Medicaid Prescription Claim Reimbursement form below with a note explaining why you paid cash. Be sure to include the drug name and attach the receipt from the pharmacy. Download the Medicaid Prescription Claim Reimbursement form (PDF).
A PDL is a list of prescription drugs approved by your health plan. The PDL contains both prescription and over-the-counter (OTC) drugs. We talk to doctors and pharmacists to come up with this list. These medical experts choose a range of generic and brand-name drugs. They look at factors like safety, quality, and cost. View the Meridian Preferred Drug List (PDF).
A doctor may need to prescribe a drug for you that is not approved in your plan. Your doctor can fill out a PA request form (PDF) that notes your medical history and why you need the drug. We must approve the drug before you can fill the prescription.
You and your doctor will get a letter that says why we did not approve the request. If you disagree, you can make an appeal for a review. This letter will explain how.
Some drugs have limits to how much you can take safely. Limits are based on research and the FDA. The QL is the amount of a drug that can be filled safely each month. Your provider must fill out a PA request if they feel you need more medication.
There may be more than one prescription drug that could treat your health condition. However, your provider must prescribe them one at a time. If the first drug does not work for you, then you can try another option. Your healthcare provider or pharmacist will help outline your treatment plan.
Call our Pharmacy Services Team at 855-580-1688. If you need more information about our pharmacy services, check out your Member Handbook.
Learn More
Get in Touch: For more information, call our Pharmacy Services team at 855-580-1688.