pharmacy services to help you live brighter
We want to make sure you and your family can get the prescriptions you need—at no cost. Learn more about your pharmacy benefit below.
Questions? Call our Pharmacy Services team at 855-580-1688.
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.
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.
When you need medicine, it will likely come from our Preferred Drug List (PDL) (PDF). 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.
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 stateissued 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 form.
A PDL is a list of prescription drugs approved by your health plan. The PDL contains both prescription and over-thecounter (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. Check out the Illinois Formulary Quarterly Summary (PDF) for updates to the PDL.
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.
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