Coordinated Care is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Coordinated Care members. Coordinated Care covers prescription medications and certain over-the-counter medications with a written order from a Coordinated Care provider. The pharmacy program does not cover all medications. Some medications may require prior authorization and some may have limitations. Other medically necessary pharmacy services are covered as well.
Use our Medicaid Preferred Drug List to find more information on the drugs that are covered.
Please use the search function or select View All to locate the drug specific Coordinated Care prior authorization form that should be used when submitting an authorization request.
Pharmacy Maximum Allowance cost (MAC) Appeal
As of 5/1/2017, US Script MAC appeals are being managed by CVS Caremark®. All US Script MAC appeals must be submitted using the MAC Appeal Form that can be accessed via the CVS Caremark Pharmacy Portal at https://rxservices.cvscaremark.com.
- Provider Preferred Drug List (UPDATED July 2017)
- In Network Pharmacies
- Network Pharmacies offering Flu Shots 2017-18
- Psychotropic Medication Prior Authorizations for Children
- Maintenance Drug Program (90 Day Supply via Mail Order or Retail)
- Specialty Pharmacy Program (Specialty Drugs Available via AcariaHealth)
- Biopharmaceutical Prior Authorization List (Provider Buy and Bill – Dispense from Office Stock)
- Preferred Drug List (PDL)/Non-Formulary Prior Auth Request Form
- Preferred Drug List (PDL) Change Request Form
- Biopharmacy/Buy-Bill Prior Authorization Form (NEW)
- Specialty Pharmacy Drug/Disease Specific Request Forms
- All Other/Non-Specific Specialty Pharmacy Request Form
- Prescription Claim Reimbursement Form
Pharmacy Benefit Manager (PBM): Envolve Pharmacy Solutions
Envolve Pharmacy Solutions, Coordinated Care's PBM, processes pharmacy claims and administers the medication prior authorization process.
Telephonic Prior Authorization: 1-855-757-6565 (available 5 a.m. - 5 p.m. PST)
Maintenance Drug Program
Coordinated Care provides members with 90 day supplies through our preferred mail order pharmacy, Homescripts, or other participating retail maintenance drug pharmacies. The Maintenance Drug Program provides details of the products that can be dispensed as part of this benefit.
To transfer a current prescription or phone a prescription directly Homescripts call 1-800-785-4197.
Members can also obtain a 90 day supply (3 month supply) of their maintenance medications from participating retail maintenance drug pharmacies.
Specialty Pharmacy Program: AcariaHealth
AcariaHealth, Coordinated Care's preferred specialty pharmacy vendor, can supply a number of products. Some of these products can be delivered directly to the provider’s location for office administration by Coordinated Care's preferred specially pharmacy provider, AcariaHealth.
For a complete listing of products that AcariaHealth can supply, please see the Coordinated Care Specialty Pharmacy Program (link to pdf).
Other Network Pharmacies
To find a pharmacy that is in the Coordinated Care network, you can use the Find a Provider tool. Click on the Provider Directory then enter the city or zip code and click Update. Choose Other and type the name of the pharmacy or select the pharmacy type in the Select Specialty area. Only the network pharmacies are listed.