CountyCare - CountyCare Pharmacy Benefits

CALL US 312-864-8200


Coronavirus Information For Members and For Providers

CountyCare Pharmacy Benefits

Help prevent the spread of Coronavirus

CountyCare is asking members to prevent the spread of Coronavirus. To limit your travel, you may be eligible for an early drug refill or to receive medicines by mail. Many pharmacies are now offering free medication delivery (including Walgreens, CVS, Jewel-Osco and others). The CountyCare Pharmacy Help Desk is available 24 Hours a day, 7 days a week at 1-888-402-1982 to help you access your medications.

CountyCare Members who would like to use MedImpact's Mail Order Pharmacy should follow the steps outlined here.

Pharmacy Updates for Members

Medicaid Preferred Drug List (PDL)

On January 1, 2020, County Care will cover medications that are selected by Illinois Medicaid.  These changes may or may not affect you. Some medications will still be covered because of the disease they treat (this is called "grandfathering”).  You can see the CountyCare selected drugs by clicking on the link below titled "Download Medicaid Formulary".

If you and your doctor decide that you cannot take a certain medication, you may need a medication that is not on the selected list.  The medication may need a special review because of your age, the amount of drug you may need, or earlier drug treatments used.  Your doctor can get a special review (Prior Approval process) by calling 888-402-1982.

For members where medication changes will be needed, you will get a letter about these changes from CountyCare. If you have questions about these changes, you can call the Pharmacy Help Desk by telephone (888-402-1982).

Questions? View the Member Single Preferred Drug List FAQ.

As a CountyCare member, your prescription drugs are provided at no cost to you when you have your prescriptions filled at an in-network pharmacy.  Your pharmacy coverage is through our vendor, MedImpact.

To get your medication, you need a prescription written by your provider.  You can take your prescription to one of our in-network pharmacies.  Our pharmacy network includes national retail chains such as CVS, Kmart, Kroger, Walgreens, Target, Osco, and Walmart.  Make sure you have your CountyCare ID card to show at the pharmacy.

If you see a Cook County Health provider, you may also use the Cook County Health pharmacies.  If your PCP is part of a community health center, you may be able to use their pharmacy to get your prescription.

You can look at the list of medications that we cover on our CountyCare Medicaid Formulary.  You can find the Formulary on our website at: www.countycare.com under Members- Pharmacy Benefits.  If you do not have access to the Web, please call Member Services and we will mail you a paper copy.  If you need a medication that does not appear on the Formulary, your provider can ask for a prior authorization formulary request.

If you are new to CountyCare, you can continue any medication that you currently use for your first 90 days with us, even if it is not a part of the CountyCare Formulary. You will be told how you and your provider can ask for a prior authorization formulary request.

CountyCare also covers over-the counter medications.  You will need a prescription from your provider to have the over-the-counter drug covered.

Medications not covered on the CountyCare Formulary

  • Weight loss drugs
  • Fertility drugs
  • Experimental or investigational drugs
  • Certain vitamins and minerals
  • Cosmetic drugs
  • Erectile dysfunction drugs
  • Drugs classified as ineffective

Pharmacy Locator

CountyCare has a large pharmacy provider network that allows you to fill your prescriptions at a location that is convenient and close to you.  Click here to find a pharmacy.

Prescription Drug Services Prior Authorizations

Some prescription drugs require a prior authorization. Your doctor can submit a Prior Authorization Form to request approval for a drug that is non-preferred or preferred by prior authorization only, on CountyCare's Formulary.

CountyCare works with MedImpact to administer pharmacy benefits, including the pharmacy prior authorization process. CountyCare requires prior authorization for select drugs on the Formulary as well as certain drugs not listed on the Formulary. Follow these steps for completing your pharmacy prior authorization requests:

  1. Complete and submit online the Medication Reqeust Form
    - or -
    Complete and print the MedImpact form: Medication Request Form
  2. Fax the completed and printed form to MedImpact at 1.858.790.7100.
  3. Once approved, MedImpact notifies the prescriber by fax and the member by letter.
  4. If the clinical information provided does not support the reason for the requested medication, MedImpact will notify the prescriber by fax, offering formulary alternatives. The member will also receive a letter regarding the decision.
  5. For urgent or after-hours requests, a pharmacy can provide up to a 72-hour supply of most medications by calling the MedImpact Pharmacy Help Desk at: 1-888-402-1982.
  6. All pharmacy prior authorization requests for CountyCare members should be submitted to MedImpact.

Specialty Pharmacy Services Prior Authorization

To submit a specialty pharmacy prior authorization, please complete and submit online the Medication Request Form or fax the printed Medication Request Form to MedImpact at 1.858.790.7100.

Formulary Exception Requests

To submit a Formulary Exception Request please complete and submit online the Medication Request Form or fax the printed Medication Request Form to MedImpact at 1.858.790.7100.

MedImpact Portal

Log in to the MedImpact portal to check the status of your prior authorizations, get information on the medications you are taking or to print out a list of your medications.


  

©2016 COOK COUNTY HEALTH AND HOSPITALS SYSTEM. ALL RIGHTS RESERVED.