Your Pharmacy Benefits
Below you’ll find important information about your pharmacy and drug coverage.
Explanation of Benefits
When you use your prescription drug benefits, we will send you an Explanation of Benefits statement in the mail. The statement will include:
- A list of your prescription drugs covered by CCA
- The amount of money that CCA pays to cover your prescriptions
- Instructions for how to request an exception and appeal our coverage decisions
- A list of upcoming changes to the list of drugs that CCA covers
Search for Covered Drugs
CCA covers a wide range of both over-the-counter, brand-name and generic prescription drugs at no cost to you. Find out if a medication is covered under your plan and what to do when it’s not.
CCA Medicare Advantage Plans Coverage
CCA Medicare Dual Special Needs Plan Coverage
Coverage Determinations and Redeterminations
For some drugs, you will need to get approval (“prior authorization”) from CCA Health Michigan before we can agree to cover a drug for you. The requirement for getting approval in advance may also help to guide appropriate use of certain drugs. If you do not get this approval, your drug might not be covered by the plan. To learn more, view the documents below.
If your request for coverage for a prescription drug was denied, you have the right to ask for an appeal of our decision within 60 days of the Notice of Denial.
Find a Pharmacy
Real-time Benefit Tool
What’s my out-of-pocket expense? Current members can verify their up-to-date medication costs at pharmacies of choice.
Click below to price your medications.
CCA Health Michigan is committed to protecting the health and safety of our members. We monitor alerts from the U.S. Food and Drug Administration (FDA) about drug recalls and withdrawals. We will notify you and your prescriber if we learn of potential problems with a medication.
A drug recall is when a medication or an over-the-counter product is removed from the market. A drug can be voluntarily recalled by the drug company and the FDA, or the FDA can require a recall. The FDA makes sure that recalls are handled correctly to safely stop the drug from being sold.
A drug may be recalled for many reasons, like safety concerns, mislabeling, or because it was poorly produced by the company.
Do not stop taking your medication until you speak to your doctor. In some cases, stopping a medication suddenly can cause a return of your symptoms that can be worse than before. In other cases, stopping a medication suddenly can be life-threatening. Follow these steps:
- Contact your doctor to discuss your options.
- Contact your pharmacy to discuss possible substitutes. For example, the pharmacist may be able to get the same medication from a different drug company. If not, they can contact your doctor to switch to another drug.
Visit the FDA website1 to learn more and to sign up to receive alerts on drug recalls.
Medication Therapy Management (MTM) Program
Our Medication Therapy Management Program (MTMP) is focused on improving therapeutic outcomes for Medicare Part D members.
Better therapeutic outcomes for members with multiple conditions.
Our Medication Therapy Management Program (MTMP) is focused on improving therapeutic outcomes for Medicare Part D members. To qualify for MTMP, a member must meet all the following criteria:
Members must have filled eight or more chronic Part D medications; and Members must have at least three of the following ten chronic conditions:
- Chronic Obstructive Pulmonary Disease (COPD)
- Congestive Heart Failure (CHF)
- High Blood Pressure
- High Cholesterol
- Rheumatoid Arthritis
- Members must be likely to incur 2024 annual costs of $5,330 for all covered chronic Part D medications.
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