CountyCare - CountyCare Pharmacy Benefits

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CountyCare Pharmacy Benefits

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).

CountyCare provides your prescription drug coverage through our vendor MedImpact.  We use a Preferred Drug List (PDL).  A PDL is a list of the drugs that we prefer you use. If you need a medication that does not appear on the PDL, your doctor may ask for a review. If you are new to CountyCare, you can continue any medication that you are currently using for your first 90 days with us.

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 not on the Preferred Drug List or a prescription requires review.

CountyCare works with MedImpact to administer pharmacy benefits, including the pharmacy prior authorization process. CountyCare requires prior authorization for select drugs on the PDL as well as ALL drugs not on the PDL. Most specialty drugs are not on the PDL and require prior authorization as described below.

Follow these steps for efficient processing of your pharmacy prior authorization requests:

  1. Complete the MedImpact form: Medication Request Form
  2. Fax to MedImpact at 858-790-7100
  3. Once approved, MedImpact notifies the prescriber by fax.
  4. If the clinical information provided does not explain the reason for the requested prior authorization medication, MedImpact responds to the prescriber by fax, offering PDL alternatives.
  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: 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 the Medication Request Form. And fax it to MedImpact at 858-790-7100.

Formulary Exception Requests

To submit a Formulary Exception Request please complete and submit the Medication Request Form and fax it 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.