Benefits overview

Pharmacy benefits

Prescription drugs

We cover most drugs. This includes injections. Drugs on the Preferred Drug List (PDL) do not need authorization. Your doctor has to authorize drugs that are not on the list.

Drug exceptions

If your doctor feels that you need a medicine that is not on the list of drugs we will pay for, you may request a Drug Exception. Some reasons for an exception are:

  • You are allergic to the other drug options on the list
  • You tried the approved drug(s) and they did not work
  • You cannot take the approved drug

If you have any questions please call us at 800-327-8613 or TTY 800-424-1694 or you may have your doctor call us at 800-327-8613 to ask for an exception.

Over the counter

You can get your over the counter medicines and supplies. The limit for over the counter drugs is $25 a month. 

All covered over-the-counter items are either a medicine, ointment or spray, or used for treatment of a condition with active medical ingredients. First aid supplies including bandages, dressings, and non-sport tapes are also covered.

When an item is covered by Part B or Part D because of a special condition, you would not use your over-the-counter benefit to get the item. This item is instead covered by Medicare. When this happens, your over-the-counter benefit amount will not be affected for the Medicare covered item.

Specialty medications

Magellan Complete Care is working with Magellan Rx Specialty pharmacy to make it easy for you to quickly get your specialty medicine. These medicines often need special storage or handling. This specialty pharmacy will help you by providing written information about your condition and medicine. You get free delivery of your medicine to your home or another address. And nurses are there to answer your questions. 

You can call the specialty pharmacy at 866-554-2673 or TTY/TDD 800-424-0328. If you do not want to use Magellan Rx Specialty pharmacy, you can them and let them know.

 

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