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Need a pharmacy prior authorization?

If you need assistance with your pharmacy benefits please contact Pharmacy Customer Service at 1-866-236-5936. They are available 24 hours, seven days a week, 365 days a year.

Pharmacy Network

 Prescription Drug List

Prescription Mail Order Services 

Did you know you could have your medications delivered to your home and save money? Instead of driving to the pharmacy and standing in line, consider having your prescriptions delivered right to your door.

If interested here are your next steps:

Step 1: Go to Novixus.com

Step 2: Set up a profile using the Rx information off your member benefits card

Step 3: Once your web profile is set up, call Novixus at 1-877-668-4987. Novixus will gather your doctor’s information and contact your doctor for you. Novixus will then set up your prescription on 90-day mail order.

It’s just that easy.

Need to obtain prior authorization or request a drug coverage exception?

Specialty Pharmacy Program

What is a specialty drug?

Specialty medications are generally prescribed to treat complex and/or chronic conditions, such as multiple sclerosis, hepatitis C and rheumatoid arthritis.

 

These medications may be taken by mouth, injection or infusion and have special handling or storage requirements and may not be stocked by retail pharmacies.

 

Specialty medications that require professional services for administration are usually covered under your medical benefit plan.

 

Coverage for self-administered specialty medications is provided through your pharmacy benefit plan.  

 

How to access

Your plan may require you to get self-administered specialty drugs through MHC's preferred specialty pharmacy or another in-network specialty pharmacy.

 

Specialty medications are designated as Tier 4 medications in MHC'S list of covered drugs (formulary). Certain Tier 4 specialty medications require prior authorization, and your provider may submit a coverage request by using our existing medication prior authorization form or by calling UUHP Pharmacy Customer Service at 866-236-5936.

Drug List Abbreviations and Terms 
 

For each drug on our lists, find additional information and requirements including: 

Tier: The numbers refer to drug copay tiers. Tier 0 drug copays are waived under the Affordable Care Act. Tier 1 drugs have the lowest copay and are typically generics. For Tier 2 drugs you will have a mid-range copay. For Tier 3 drugs you will have a high copay. Tier 4 drugs are specialty drugs.

PA, Preauthorization: Pre-authorization helps encourage safe, cost-effective use of prescription drugs by requiring a "prior authorization" request from your physician before the drug will be covered. If PA appears in the Requirements column, the drug requires pre-authorization from your physician before the drug will be covered. 

QL, Quantity Limits: QL stands for quantity limits. If QL appears in the requirements column, the drug may be covered by your plan, but only up to a certain quantity or limit. If you need quantities higher than the limit shown, have your provider fax a preauthorization request to us.

SP, Specialty Drug: SP stands for specialty or biotech drug. In most cases, specialty drugs are required to be filled at a designated specialty pharmacy. Check your member handbook or Summary of Benefits to find the specialty drug copay amount or deductible amount. 

ST, Step Therapy: SP stands for Step Therapy, a program that requires you to try a lower-cost alternative medication ("Step 1 Drugs") before using the more expensive ("Step 2") medication. If it is medically necessary for you to use a Step 2 medication as initial therapy, your provider can submit an exception request to us. 

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Montana Health CO-OP does not discriminate on the basis of race, color, national origin, disability, age, sex, gender, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

 

Contact Us with Questions About Coverage