Pharmacy
HAP CareSource MI Coordinated Health partners with Express Scripts® to help you manage your prescriptions.
Prescription Drug Benefits
With HAP CareSource MI Coordinated Health, you get more of the medications you need with no copays for covered Medicare Part D drugs and some Medicaid covered non-Part D and over-the-counter (OTC) drugs.
The List of Covered Drugs (Formulary) lists both the Medicare Part D and Medicaid drugs covered under your plan. Some drugs have restrictions and/or limits like prior authorization, step therapy, and quantity limits.
Throughout the year, changes may occur to drugs on our formulary. Check the Notice of Formulary Changes (coming soon) to view the updates.
View the links below for more pharmacy topics:
- Find My Prescriptions
- Find a Pharmacy
- Mail Order Drugs
- Medication Therapy Management
- Medication Disposal
- Medicare Prescription Payment Plan
- Drug Transition Policy
Ask Your HAP CareSource Pharmacist
Do you have questions about your medications? Talk to a HAP CareSource pharmacist! You do not need an appointment. Call 1-833-230-2073 (TTY: 711) to speak with a pharmacist today. We are open Monday through Friday, 8 a.m. to 5 p.m. Eastern Time.
Step Therapy Criteria
For certain drugs, we require you to first try another drug to treat your medical condition before we will cover the drug your doctor initially prescribed.
Prior Authorization Criteria
For certain drugs, your prescriber will need to contact us before you can fill your prescription.
Visit the Plan Documents to see the Part B (medical drugs) Prior Authorization List.
Generic vs. Brand Name Drugs
It is the policy of HAP CareSource MI Coordinated Health to limit the use of a brand name drug when a generic version is available. Generally, a generic drug works the same as a brand name drug and usually costs less. Please see your Member Handbook/Evidence of Coverage for exceptions.
Drug Safety Recalls
Sometimes, the federal government or drug manufacturer issues drug recalls. To find out if a drug you take is being recalled, please check the listings on the Food and Drug Administration (FDA) website.
Quality Assurance
We look at pharmacy claims to make sure drug use is safe and effective. We have system edits to support the pharmacy when they process your prescriptions, to help avoid errors and negative drug interactions.
In general, the formulary (or drug list) stays consistent throughout the year. If you are taking a drug that was on the list at the beginning of the year, we will not end or reduce coverage for the drug during the year unless a new, less expensive generic version of the same drug becomes available, or if there is a new adverse information about the safety or effectiveness of a drug. If a new generic version of the drug becomes available, we will not notify you and the pharmacy will fill your prescription with the generic drug.
We update the formulary monthly to make sure information is accurate and up-to-date. This process includes approval through CMS/MDHHS for any changes. For some changes, we notify you. We give 30 days notice to you when we:
- Take a drug off the list.
- Add or change prior authorization rules.
- Add or change a quantity limit.
- Change a cost tier.
You can access an online formulary or print one from our website. You may also ask us to mail you a copy. Just call Member Services at 1-833-230-2057 (TTY: 1-833-711-4711 or 711).
Non-Opioid Directive Form
With the Non-opioid Directive form (English | Spanish | Arabic), you can tell your providers when you do not want to get opioids. You (or legal guardians) who want to use this directive can download and fill out the form. Give a copy to your health care providers, including dental providers.