It’s important to IlliniCare Health that our members receive the right prescription drug coverage and appropriate drug therapy. It is important to IlliniCare Health that it is also high quality and cost effective. We work hard to ensure you have access to safe and effective medications that are medically proven to help you get healthy and stay healthy. Pharmacy not covered under MLTSS.
IlliniCare Health covers certain prescription drugs and over-the-counter drugs when prescribed by an IlliniCare Health provider. The pharmacy program does not cover all drugs. Some require prior authorization. Some drugs have limitations on age, dosage or maximum quantities.
The preferred drug list (PDL) is the list of drugs covered by IlliniCare Health. IlliniCare Health works with providers and pharmacists to ensure that prescription medications used to treat a variety of conditions and diseases are covered under the pharmacy benefit. The PDL applies to drugs you receive at retail pharmacies. The IlliniCare Health PDL is frequently reviewed by the Pharmacy and Therapeutics Committee. The committee promotes the appropriate and cost-effective use of medications.
View the Preferred Drug List (PDF).
If your medication is not on the preferred drug list or is on the preferred drug list but has limitations, you can:
- Speak with your doctor about switching to a similar medication that is on the preferred drug list.
- Request a prior authorization, or speak to your doctor about submitting a prior authorization for you. You or your doctor may do this by submitting the Medication Prior Authorization Form, or by calling (800) 460-8988.
You can have your prescriptions filled at a network pharmacy. At the pharmacy, you will need to give the pharmacist your prescription and your ID card. If you need help finding a pharmacy near you, call us.
IlliniCare Health also offers a 90 day supply (3 month supply) of maintenance medications by mail. These drugs are used to treat long-term conditions or illnesses. A list of maintenance medications can be found by accessing the Maintenance Drug Pharmacy Program. To transfer a current prescription, request a prescription refill, or have your doctor phone a prescription directly to our mail order pharmacy, call Homescripts at (888) 239-7690 or go to the Homescripts webpage.
To find a pharmacy that is in the IlliniCare Health network, you can use the Find a Provider tool. Type in your city or zip code. Then click Update. Choose Other. Type the name of your pharmacy. You can also select the pharmacy type in the Select Specialty area. Only those pharmacies in the IlliniCare Health network are listed.