My Prescriptions

The following is the comprehensive list of covered drugs (formulary) that includes over-the-counter drugs as well as drugs covered by Medicare Part B and Part D and Medical Assistance.

To receive a covered drug:

• Have your health care provider write a prescription for it
• Take the prescription to a pharmacy in the Medica network

The pharmacist will fill your prescription with a generic version of the drug if one is available. If there is no generic version, the pharmacist will give you a name brand version.

View drug lists

Need Help with Paying for Part D?

If you qualify for extra help, you’ll get a Low Income Subsidy (LIS) rider. This means that you will get help paying your monthly premium and prescription drug cost-sharing. There are three levels of extra help, based on your income. As a member of our plan, you'll get the same coverage as someone who is not getting extra help. Your membership in our plan will not be affected by the extra help. This also means that you must follow all the rules and procedures in your Member Handbook.

We offer coverage of some supplemental prescription drugs not normally covered in a Medicare Prescription Drug Plan. These drugs are covered through Medical Assistance (Medicaid). Please see the chart below:

Level of Extra Help

These amounts are effective January 1, 2021.

Once the amount both you and Medicare pay (as the Extra Help) reaches $6,550 in a year, your copayment amount will go down to $0 per prescription

Specialty drugs are used to treat certain complicated health problems. These drugs tend to be very expensive and may need special handling and monitoring.

If you are prescribed a drug that is on our specialty drug list, your prescriber will need to send the prescription of that specialty drug to our preferred specialty pharmacy, Accredo Specialty Pharmacy.*

2021 specialty drug list (PDF) 

How to Fill a New Specialty Drug Prescription

Step 1: Check the specialty drug list, which shows all of the medications Medica considers specialty drugs.

Step 2: Your plan may not cover all of the drugs on the specialty drug list. To find out about your coverage for a specialty drug, please call Medica Member Services.

Step 3: Once you've verified your coverage, fill your prescription through Accredo Specialty Pharmacy.*

   •  First time filling a prescription – Call Accredo to set up an account. Have your Medica ID card ready when you call.

   •  Refilling an active prescription – Create an account on the Accredo Patient Portal to manage refills.

       Accredo Patient Portal

Questions?

Accredo Specialty Pharmacy Customer Service
Toll-free: 1-866-544-6817 (TTY: 711)
7 a.m. – 10 p.m. Central, Monday through Friday
7 a.m. – 4 p.m. Central, Saturday

* There are a small number of drugs not available through Accredo Specialty Pharmacy. These drugs may be considered limited distribution by the manufacturer and must be obtained through a different specialty pharmacy. These drugs have a “*” next to them in Medica’s specialty drug list.

Your provider typically knows where to send prescriptions for limited distribution drugs, but if you have any questions, contact Accredo Specialty Pharmacy.

If you fill your specialty drug prescription through a vendor other than Accredo Specialty Pharmacy*, your drug will not be covered and you will be responsible for the entire cost.

Some drugs need approval or Prior Authorization before you get your prescription filled. You or your health care provider can request Prior Authorization approval from Medica.

You must get approval from Medica before you can fill your prescription for these drugs or Medica may not cover the cost.

Prior Authorization

It is important for your health care provider to fill the form out as completely as possible and list which medications have been tried and failed. Please include the dosages that were used and the reason why the drugs didn't work (e.g.: side effects or effectiveness).

Prior Authorization Coverage Determination Request Form

• Request for Prescription Drug Coverage Determination online form
• Request for Prescription Drug Coverage Determination paper form (PDF)

Appeals and Denials

If your Prior Authorization request for coverage of a prescription drug was denied and you want to appeal the decision, please fill out the form below.

Coverage Redetermination Request Form

• Request for Redetermination of Medicare Prescription Drug Denial online form
• Request for Redetermination of Medicare Prescription Drug Denial paper form (PDF)