Pharmacy and prescription drugs
Your benefits include a wide range of prescriptions and over-the-counter medicines. We work with Express Scripts (ESI) to provide these benefits.
Find a pharmacy
To find a pharmacy near you, use the ESI pharmacy locator tool.
Fill a prescription
Bring your member ID card and prescription to the pharmacy. Your doctor can also call in the prescription for you.
You don’t have a copay for your prescription drug benefits.
Drug coverage information
Preferred Drug List (PDL)
The Preferred Drug List (PDL) has the medicines your plan pays for as long as you have a prescription. This includes over-the-counter (OTC) medicines. Your doctor doesn’t have to check with the plan before prescribing these for you. The PDL is updated frequently.
Don’t see it listed?
If you don’t see your medicine listed on the PDL, you may ask for an exception at email@example.com. You’ll 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 Summit Community Care before your provider can prescribe them.
For those medicines, your provider will need to call 1-844-462-0022 to get approval. If your provider needs approval from us before you can get your prescription filled, you may be able to get a 72-hour supply while you wait.
Drugs that require preapproval include those that:
- Can have high side effect potential
- Should be prescribed only for specific usage
- Have a high misuse or abuse potential
- May cost more than other preferred drugs (e.g. brand-name drug when an FDA-approved generic version is available)
- Are part of a step therapy treatment plan
- Are prescribed at a higher dosage than recommended
The preapproval process helps us make sure that you’re taking medications safely and correctly. If you misplace your medicine or it is stolen, contact your provider. They will work with the pharmacy and Summit Community Care to review your case and replace your medicines as needed.
Drug interactions and side effects
Learn more about drug interactions or side effects on the Express Scripts Drug Information page.
Express Scripts (ESI) forms
If you had to pay for a medicine that is covered under your plan, you may submit a request for reimbursement form.
You can manage your prescriptions online through ESI.
Mail order prescriptions
You can get many prescription drugs shipped directly to your home through Walmart.