Pharmacy & Prescription Drug Benefits
Prime Therapeutics State Government Solutions LLC provides our pharmacy benefit to full Medicaid and LaCHIP members. When you need to fill your prescriptions, you must go to a pharmacy that works with Healthy Blue. We cover a wide range of prescriptions, certain over-the-counter medicines, and now even bug spray.
Find a local pharmacy nowSee which drugs we pay for
We have a list of drugs we’ll pay for. This is called a formulary. We won’t pay for drugs that aren’t on the formulary unless you get an OK from us first. This is called an exception. Use the online list of drugs to find name brand and generic drugs we pay for.
Healthy Blue formulary
You can search for drugs on this list from the Louisiana Department of Health.What you get
Our pharmacy benefit covers a wide range of prescriptions, over-the-counter medicines, and now bug spray for our Medicaid and LaCHIP members.
Have your prescriptions filled easily
Just show the prescription from your doctor to a pharmacy in your plan. Or your doctor can call in the prescription. You’ll need to show the pharmacy your Healthy Blue member ID card and your Medicaid ID card to get your prescription. Try to use the same pharmacy each time so your pharmacist will know about problems that may occur when you’re taking more than one prescription. If you use another pharmacy, tell the pharmacist about any medicines you’re taking.
Your costs
When you go to your PCP or another provider, you might get a prescription for medicine. We will pay for your prescriptions, but you may have a small copay. A copay is the amount you pay for a drug if you have Healthy Blue.
| Cost of the drug | What you pay* |
|---|---|
| $10 or less | $0.50 |
| $10.01 - $25 | $1 |
| $25.01 - $50 | $2 |
| Over $50 | $3 |
*There are no copays for members with a monthly household income of $800 or less. Payments are not applied once 5% of a member's family income is spent on copays. There are also no copays for:
- Children
- Pregnant women
- Family planning supplies
- Members in the hospital
- Members of a home and community based waiver
- Women who have Medicaid due to breast or cervical cancer
- Members getting hospice services
- Native American or Alaska Native members
Pharmacy benefits for behavioral health members
Members who only receive behavioral health services through Healthy Blue will get their pharmacy benefits through Louisiana Medicaid Pharmacy Fee For Service Program. Call 1-800-437-9101 for more information.
If you have Medicare Part D Drug coverage, you’ll still get your medications reimbursed through your Part D plan.