Pharmacy

See what drugs are covered under your plan, find a pharmacy near you, and more. Explore all pharmacy-related information for your plan by browsing the links below.

For more information on how to fill your prescriptions, please review the Member Handbook.

Pharmacy Search

To find a pharmacy near you, use our Online Pharmacy Search tool.

Provider Forms

• CoverMyMeds Prior Authorization Forms

• Drug Exception Form (PDF)
• Fax Discharge Form (PDF)
• Medicaid Health Plan Pharmacy Carve-Out (PDF)
• Medication Prior Authorization Request Form (PDF)
• Medical Outpatient Prior Authorization Request Form (PDF)

Member Forms

• Member Reimbursement Form (PDF)
• Member Internal Appeal Form (PDF)
• Member Authorized Representative Form (PDF)

MAC Appeal Information

• ESI MAC Appeal Instructions (PDF)