While Buckeye covers all medically necessary Medicaid-covered medications, we use a preferred drug list (PDL). These are the drugs that we prefer that your provider prescribe. We may also require that your provider submit information to us (a prior authorization request) to explain why a specific medication and/or a certain amount of a medication is needed. While you are waiting for approval, you may receive a three day supply of the prescribed medication. If we approve the prior authorization request, your pharmacist will fill the remainder of the prescription. Reasons why we may prior authorize a drug include:
- There is a generic or pharmacy alternative drug available.
- The drug can be misused/abused.
- There are other drugs that must be tried first.
Some drugs may also have quantity (amount) limits and some drugs are never covered, such as drugs for weight loss.
If we do not approve a prior authorization request for a medication, we will send you information on how you can appeal our decision and your right to a state hearing.
You can find both the PDL and list of medications requiring prior authorization using the links on this page. You can also find the Maintenance Drug List. Please note that our PDL and list of medications that require prior authorization can change so it is important for you and/or your provider to check this information when you need to fill/refill a medication. You can also call member services to request information on our PDL and medications that require prior authorization.
Buckeye members have a $2 copayment for brand-name prescription medications, with some exceptions. There is no copay if the brand name medication does not require a copay under fee-for-service Medicaid and there is no co-payment for generic medications. Ask your provider to prescribe generic medications if possible so that you will not have a copayment.
Additionally, there is no co-payment if the member is:
- younger than 21; or
- pregnant, or her pregnancy ended recently (up to 90 days ago); or
- in a nursing home; or
- given the medication during a hospital, emergency room, clinic, office or other facility visit; or
- getting services related to family planning; or
- getting hospice care.