Drug Coverage Information

Drug Coverage Information

CMS announces delay in the requirements for Prescribers of Part D Drugs until January 1, 2019 to Access the Information click here

  • Independent Care Health Plan Medicaid SSI And BadgerCare Plus Drug Coverage

    The pharmacy benefit for members of iCare Medicaid SSI and BadgerCare Plus is managed by the state of Wisconsin.  Please call the state provider services line at 1-800-947-9627 for information regarding drug coverage.

  • Independent Care Health Plan Medicare Plan and Independent Care Health Plan Family Care Partnership Drug Coverage

    The pharmacy benefits for iCare Medicare Plans and iCare Family Care Partnership are managed by iCare.  Each plan utilizes a formulary approved by CMS which includes both brand and generic medications.  For certain medications, there are additional requirements for coverage or limits on the coverage.  These are indicated within the formulary as PA (Prior Authorization), ST (Step Therapy), or QL (Quantity Limit).  A list of our covered drugs, as well as descriptions of the additional requirements or limits on the coverage can be found within the Comprehensive Formularies below.  Details regarding prior authorization requirements or step therapy criteria are also posted on this page. 

  • Notice Of Formulary Changes

    The formularies may change slightly during the year as new drugs become available or new information is released regarding a drug’s safety or efficacy.  In most cases, CMS requires that we notify all authorized prescribers and pharmacists 60 days prior to removing a covered Part D drug from our formulary or changing the preferred status of a covered Part D drug.  Please see Provider Forms & Publications for applicable Formulary Change Notices.

  • Requesting Prior Authorization Or A Formulary Exception

    As indicated within the formulary, a Prior Authorization is required on certain medications before they will be covered.  Links to the Prior Authorization forms are located below.  We have also provided additional details regarding prior authorization requirements and step therapy criteria.

    When the medications on our formulary used to treat a specific condition are not appropriate for a patient, you may request coverage of a non-formulary medication.  This type of request is called a Formulary Exception.   An exception may also be requested to the Step Therapy criteria when first-line agents are not appropriate for your patient, or to the Quantity Limit restrictions when the allowed quantity is not enough to adequately treat your patient’s condition.  The Prior Authorization forms located below may be used for formulary exceptions as well.  Supporting medical information must be submitted with any exception request.  The requests should be faxed to our Pharmacy Benefits Manager, MedImpact, at 858-790-7100.

    Or, you may click here to submit a prior authorization through the web. You will be redirected to MedImpact's website.

  • Medication Therapy Management Program

    A Medication Therapy Management (MTM) program is a program that may be furnished by a pharmacist and is designed to assure that the drugs of Medicare beneficiaries are appropriately used to optimize therapeutic outcomes and to reduce adverse drug events.

    MTM programs target members who have multiple chronic diseases, are taking multiple Part D drugs, and are likely to incur annual costs for covered Part D drugs that exceed a specified level.

    Independent Care Health Plan has contracted with OutcomesMTM™ to provide MTM services to all of our members with Medicare coverage through iCare. OutcomesMTM has a network of specially trained personal pharmacists throughout Eastern Wisconsin that provide MTM services in the community pharmacy and Long Term Care setting. As part of the MTM program, each member is invited to participate in an annual face-to-face consultation with a personal pharmacist to review and organize his/her medication usage and identify, resolve, and/or prevent medication-related problems. This is called a Complete Medication Review, or CMR. In addition, members also receive quarterly Targeted Medication Reviews to assess medication use since the annual medication review, monitor whether any unresolved issues need attention, or identify other new potential drug therapy problems. Issues identified during medication reviews may require the pharmacist to contact the prescriber for resolution.

    If you have questions regarding the program or would like to know if your patient is participating, please feel free to contact iCare’s Pharmacy Services Department. You may also call iCare to request that your patient receive a Complete Medication Review from an OutcomesMTM pharmacist.

    Please visit the OutcomesMTM website for additional information.

  • Electronic Prescribing

    Independent Care Health Plan supports electronic prescribing for our Medicare members through Surescripts, an e-prescribing network.  Our e-prescribing program can provide you with prescription eligibility information, basic formulary information, and patient medication histories at the point of care.  You can securely access the information using standalone e-prescribing software or an Electronic Medical Record (EMR) that has been certified by Surescripts. Visit Surescripts's Website for more information.

  • Network Pharmacies
    • For more information on pharmacies in our network, please visit our Pharmacy search
Modified: 10/23/2018

  • Independent Care Health Plan
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