Prescription drug coverage

You have prescription drug coverage with your Priority Health Choice, Inc. plan. We review drug coverage routinely to help make sure you have access to safe and effective therapy.

What is covered?

We work with the Michigan Department of Health and Human Services (MDHHS), and other health plan partners, to determine what medications are covered. The list of covered medications is called the Medicaid Health Plan Common Formulary.

Use our online Approved Drug List tool to understand what is covered and how. You and your doctor should use this list when deciding what medications to take. Coverage for some drugs requires prior authorization from us. You and your doctor should contact us when prior authorization is needed.

If you are eligible for Medicare, most medications will be covered by Medicare. There are some drugs that Medicare will not pay for but that this Medicaid plan will cover, like certain over-the-counter (OTC) drugs.

What pharmacy can I use?

Use our online Find a Doctor directory to search for in-network pharmacies near you. You must use an in-network pharmacy and you should always bring a copy of your member ID card with you to the pharmacy. There is important information on the back of your ID card the pharmacy needs.

In addition to our retail pharmacy network, home delivery is available through Express Scripts for members enrolled in group 10001.

Where can I find more information?

Please reference the Member Handbook and Certificate of Coverage for more detailed information.

• Member Handbook and Certificate of Coverage
• Priority Health Choice, Inc. Medicaid plan benefit overview