Pharmacy and prescription drugs
Your pharmacy and prescription drug benefits
Your benefits include a wide range of prescription and over-the-counter (OTC) medicines for eligible members. Healthy Blue works with CarelonRx to provide these benefits. If you have questions about whether or not you are eligible to receive OTC medicines, call Member Services at 833-388-1405 (TTY 711) Monday through Friday from 8 a.m. to 5 p.m. Central time.
Find a pharmacy
To find a pharmacy near you, use our pharmacy locator tool.
Fill a prescription
Bring your Nebraska Medicaid ID, member ID, and prescription to a plan pharmacy. Your doctor can also call in the prescription for you.
It is best to use the same pharmacy each time you fill a prescription. This way, your pharmacist will know about problems that may happen when you are taking more than one medicine. If you use another pharmacy, you should tell the pharmacist about all medicines you or your child are taking.
Have your medicines mailed to you
We make filling your prescriptions as convenient as possible. You can log in to your account and manage your prescriptions filled through home delivery. With your secure online account, you can:
- Order refills.
- Request a new prescription for home delivery.
- Switch a prescription to home delivery.
- Track your shipments.
- Set up email and text notifications.
Copays are set dollar amounts you pay for a covered service, like getting a prescription filled. There is a $3 copay for brand-name prescriptions. There are no copays for generic prescriptions.
There are no copays for members age 18 or younger, pregnant women, members in a hospital, long-term care facility or residential care facility, members of a home- and community-based waiver, or Native Americans getting services through a Native American Health Care Provider.
Drug coverage information
Your benefits include a wide range of prescription drugs. Healthy Blue may also cover many over-the-counter (OTC) medicines with a prescription from your doctor. To see if you are eligible and learn what your pharmacy benefits are, you can call Pharmacy Member Services, 24 hours a day, seven days a week at 833-370-0703 (TTY 711).
Nebraska Medicaid Preferred Drug List
The Nebraska Medicaid Preferred Drug List (PDL) is a list of brand name and generic drugs available on your plan. These drugs are chosen for their quality and effectiveness. Your doctor will use this PDL first when prescribing your medicines. Most of these medicines do not need preapproval, or an “OK” from us first. The PDL is updated frequently.
Healthy Blue Preferred Drug List
We also cover medicines and supplies that are not included in the Nebraska Medicaid Preferred Drug List (PDL). You can use our Healthy Blue PDL to find things like diabetic supplies, spacers and vaccines. We chose these items for their quality and effectiveness.
The formulary is a list of all brand name and generic drugs available in your plan. It lists all the drugs found on the PDL, plus others. All drugs on the formulary are covered, but some require preapproval before the prescription can be filled.
Find your medicine
Do you want to look up your medicine and find out if it is covered in your plan? It’s easy when you use our search tool. This tool will help you learn about any limitations or restrictions for any particular drug.
You can search for your drug by:
- Typing the name (at least first three letters) of the drug in the search box.
- Using the A-Z list to search by the first letter of your drug.
- Clicking the therapeutic class of the drug.
Do not see it listed?
If you do not see your medicine listed on the drug lists, you may ask for an exception at email@example.com. You will be asked to supply a reason why it should be covered, such as an allergic reaction to a drug, etc.
Prior authorizations (preapprovals)
Some medicines need a preapproval, or an “OK,” from Healthy Blue before your doctor can prescribe them. The preapproval process helps us make sure that you’re taking medications safely and correctly.
Here are some reasons that preapproval may be needed:
- There is a generic or preferred alternative drug available.
- The drug could be misused or abused.
- There are other drugs that should be tried first.
- The drug has a high side effect potential.
- The drug is prescribed at a higher dosage than recommended.
- There is additional information needed about your condition so we can match it to the FDA approval of the drug and/or studies of effectiveness.
For medicines that need preapproval, your provider will need to call Provider Services. Healthy Blue will review the request and give a decision within 24 hours. If you need your medicine right away, you can get a 72-hour supply while you wait.
If you misplace your medicine or it is stolen, contact your provider. They will work with the pharmacy and Healthy Blue to review your case and replace the medicines as needed.
If you have any questions about your pharmacy benefit, you can reach Pharmacy Member Services, 24 hours a day, seven days a week at 833-370-0703 (TTY 711).
Get your specialty medications
If you have a complex or chronic health condition that requires special medicine, we can help. We partner with CarelonRx Specialty Pharmacy and other pharmacies to meet all your specialty medication needs.