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Pharmacy Frequently Asked Questions

 

I need to fill a prescription. What should I take to the pharmacy? 
 Take your Member ID card to the pharmacy and a personal identification card with a photo such as a driver's license or state issued ID card.

What is a List of Drugs (Formulary)?
 A List of Drugs (Formulary) is a list of prescription drugs covered by our plan. We choose the drugs on this list with the help of doctors and pharmacists. The list tells you if there are any rules you need to follow to get your drugs. The list is sometimes called a "Formulary." For more information on how to fill your prescriptions, please review your Member Handbook .

What is a Prior Authorization? 
 There may be times when your doctor orders a drug for you that is not approved on your plan’s List of Drugs (Formulary) or requires a prior authorization. Your doctor can fill out a prior authorization request form, giving facts about your medical history and why you need the drug. For more information, please visit our Prior Authorization, Step Therapy and Quantity Limits page.

What happens if the Prior Authorization is not approved?
 We may deny a drug request for medical reasons. If your request is not approved, you and your doctor will get a letter explaining why. The letter will also explain the appeal process if you and your doctor disagree with the denial. For more information, please visit our Coverage Determinations and Redeterminations for Drugs page.

What is a Quantity Limit?
 This is a drug that has a limit on the amount that our plan will cover. If your doctor feels that you need more of a drug with a quantity limit, they must fill out a prior authorization request.

What is Step Therapy? 
 Sometimes more than one drug can be used to treat a condition. Step therapy means that one drug must be tried first before another is prescribed. Your doctor or pharmacist can explain which drug must be tried first. For more information, please visit our Prior Authorization, Step Therapy and Quantity Limits page.

I have a question about a drug I am taking or have been prescribed.
 You may call Member Services for more information and to ask any questions you have about the drugs you are taking or have been prescribed.

Updated Date: 10/01/24

H6080_WEBSITE_2025_Accepted_09302024


Updated Date: 10/01/24

H6080_WEBSITE_2025_Accepted_09302024

Meridian Medicare-Medicaid Plan (MMP) is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Meridian Member Handbook. Out-of-network/non-contracted providers are under no obligation to treat Meridian members, except in emergency situations. Please call our Member Services number or see your Member Handbook for more information, including the cost-sharing that applies to out-of-network services. You can get this document for free in other formats, such as large print, braille, or audio. Call 1-855-580-1689 (TTY: 711). Representatives are available Monday-Friday, 8 a.m. to 8 p.m. to assist you. On weekends and on state or federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

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