Pharmacy and prescription drugs
Your benefits include a wide range of prescriptions and over-the-counter medicines. We work with CarelonRx to provide these pharmacy benefits. There are no copays for your prescription drug benefits.
Find a pharmacy
To find a pharmacy near you, use our pharmacy locator tool.
Fill a prescription
Bring your member ID card and prescription to a plan pharmacy. A doctor can also call in the prescription for you.
It’s good to use the same pharmacy each time you fill a prescription. This way, your pharmacist will know about problems that may happen when you’re taking more than one prescription. If you use another pharmacy, you should tell the pharmacist about all medicines you are taking.
Make fewer trips to the pharmacy
Our Medication Synchronization (Med Sync) program makes getting all your medicines easier at no extra cost to you.
Med Sync helps get your refills on the same schedule so you can pick up most of your medicines on the same day each month.Talk to your pharmacist about coordinating your prescriptions to get started.
If you have questions, call 1-833-263-2869 (TTY 711).
Have your medicines mailed to you
We make getting your prescriptions filled 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
- Track your shipments
- Get notifications
Prescription Drug Home Delivery Form
You can get many prescription drugs shipped directly to your home through an in-network home delivery provider.
In-network home delivery providers include:
- Walmart Home Delivery
Use this form to set up home delivery on your prescription:
Drug coverage information
Your benefits include a wide range of prescription drugs. Summit Community Care also covers many over-the-counter (OTC) medicines.
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 drug list, you may ask for an exception at firstname.lastname@example.org. You or your provider will be asked to supply a reason why it should be covered, such as an allergic reaction to a drug, etc.
Drug Lookup Tool
You can find out more about prescription medicines on the Drug Lookup Tool. Go to the top right corner and select Tools, Drug Lookup.
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. Some medications listed may have additional requirements or limitations of coverage. These requirements and limits may include prior authorization, quantity limits, age limits, step therapy, or Centers
for Medicare & Medicaid Services (CMS) coverage requirements.
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 on the therapeutic class of the drug.
Prior authorizations (preapprovals)
Some medicines need a preapproval, or an “OK,” from Summit Community Care before your provider can prescribe them. The preapproval process helps us make sure that you’re taking medications safely and correctly.
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
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 the medicines as needed.
If you have any questions about your pharmacy benefit, call Pharmacy Member Services 24 hours a day, seven days a week at 1-833-263-2869 (TTY 711).
Prescription Drug Reimbursement Form
If you had to pay for a medicine that is covered under your plan, you may submit a request for reimbursement form.
Get your specialty medications
If you have a complex or chronic health condition that requires special medicine, we can help. We partner with specialty pharmacies to meet all your specialty medication needs.