Get the medications you need
Your CCA One Care (Medicare-Medicaid) plan covers a wide range of both over-the-counter and brand-name and generic prescription drugs at no cost to you. Use the resources below to find out if a medication is covered by Commonwealth Care Alliance and if it requires step therapy or pre-approval.
One Care Step Therapy Criteria
Preferred Diabetes Test Strips
CCA partners with Abbott Diabetes Care and Lifescan Products to provide the following diabetes test strip products. Some restrictions may apply.
- FreeStyle (Lite, Freedom Lite, InsuLinx Systems)
- Precision Xtra System
- Freestyle and Precision Xtra Test Strips
- OneTouch Ultra2 Glucose System
- OneTouch Ultra Test Strips
- OneTouch Verio Test Strips
If you or your doctor believe you should use a different diabetes care product than those listed above, you may request an exception through the prior authorization process. Click here for information on how to request a prior authorization.
Changes to the List of Covered Drugs
We may add or remove drugs from the list of covered drugs during the year. If we remove a drug or make a change regarding a drug you use, we will notify you at least 60 days before the change becomes effective. However, if the Food and Drug Administration (FDA) determines that a drug on our list is unsafe, or if the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our list of covered drugs and notify you. Learn more about drug recalls.
You can view the latest updates to our list of covered drugs below:
As a new or continuing member in our plan, you may be taking drugs that are not on our formulary. Or you may be taking a drug that is on our formulary, but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request a formulary exception so that we will cover the drug you take. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan.
For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will cover a temporary 31-day supply. If your prescription is written for fewer days, we’ll allow refills to provide up to a maximum 31-day supply of medication. After your first 31-day supply, we will not pay for these drugs, even if you have been a member of the plan less than 90 days.
If you are a resident of a long-term care facility and you need a drug that is not on our formulary or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, we will cover a 31-day emergency supply of that drug while you pursue a formulary exception.
We will provide an emergency supply of at least 31 days (unless the prescription is written for fewer days) for all non-formulary medications, including those that may have step therapy or prior authorization requirements for an unplanned level of care change. An unplanned level of care transition could be any of the following:
• A discharge or admission to a long-term care facility
• A discharge or admission to a hospital
• A nursing facility skilled level change
What if my drug is not on the list?
If your drug is not included in the list of covered drugs, you should first contact CCA Member Services and confirm that your drug is not covered. If we do not cover your drug, you have two options:
- Ask Member Services for a list of similar drugs that are covered. Show the list to your doctor and ask him or her to prescribe a similar drug that we cover.
- Ask us to make an exception and cover your drug. Click here for information about how to file a pharmacy appeal.
In some cases, we can offer a temporary supply when the drug you have been taking is no longer on our list of covered drugs, or when the drug becomes restricted in some way. A temporary supply can give you time to talk with your doctor about what to do.
There are different rules for getting a temporary supply depending on your status as a CCA member. Contact CCA Member Services to see if you qualify.
Visit our Pharmacy Information page for more information on your pharmacy benefits.