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Get the Medications You Need

Your Choice (HMO) or Plus (HMO) plan covers a wide range of both brand-name and generic prescription drugs. Use the resources below to find out if a medication is covered by CCA Health and if it requires step therapy or pre-approval.

Download our Choice and Plus drug formulary to find your drug name or type.

Choice and Plus Drug Formulary (2022)

Download:

Drug Coverage Decision Request Form

Step Therapy Criteria (2022)

Download:

Choice and Plus – Prior Authorization Criteria (2022)

Download:


Medication Transition Process

What can you do if your drug is not on the drug list or if the drug is restricted in some way?

If your drug is not on the drug list or is restricted, here are things you can do:

You may be able to get a temporary supply

Under certain circumstances, the plan can offer a temporary supply (transition fill) of a drug to you when your drug is not on the drug list or when it is restricted in some way. Doing this gives you time to talk with your doctor about the change in coverage and figure out what to do. To be eligible for a temporary supply, you must be in one of the situations described below:

We will cover a temporary supply of your drug during the first 90 days of the calendar year. This temporary supply will be for a maximum of 31 days. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of a 31-day supply of medication. The prescription must be filled at a network pharmacy.

We will cover a temporary supply of your drug during the first 90 days of your membership in the plan. This temporary supply will be for a maximum of 31 days. If your prescription is written for fewer days, we allow multiple fills to provide up to a maximum of a 31-day supply of medication. The prescription must be filled at a network pharmacy.

We will cover a temporary supply of your drug during the first 90 days of your membership in the plan. The total supply will be for a maximum of 30 days. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of a 30-day supply of medication. (Please note that the long-term care pharmacy may provide the drug in smaller amounts at a time to prevent waste.)

We will cover a temporary supply of your drug during the first 90 days of your membership in the plan. The total supply will be for a maximum of 30 days. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of 30 days of medication. (Please note that the long-term care pharmacy may provide the drug in smaller amounts at a time to prevent waste.).

We will cover one 30-day supply, or less if your prescription is written for fewer days. This is in addition to the above long-term care transition supply.

We will cover a temporary supply for up to 31 days, or less if your prescription is written for fewer days, even if the drug is not on our formulary or the drug is subject to certain restrictions such as prior authorization or step therapy. The drug must be a Part D covered drug. The prescription must be filled at a network pharmacy.

We will send a letter after we cover a temporary supply of drugs.

We will provide with a written notice after we cover a temporary supply. This notice will explain the steps to request an exception and how to work with the provider to switch to an appropriate drug that we cover. After we cover the temporary supply, we may not pay for the drug again as part of our transition policy.

During the time when you are getting a temporary supply of a drug, you should talk with your provider to decide what to do when your temporary supply runs out. You can either switch to a different drug covered by the plan or ask the plan to make an exception for you and cover your current drug.

We’re here to support you

866-333-3530 (TTY 711)
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