Frequently Asked Questions
Q: How do I contact OHCA Pharmacy Unit?
Pharmacy contact information
Q: How do I contact the Pharmacy Help Desk?
Pharmacy Help Desk
Q: What is the connection between OU College of Pharmacy and OHCA?
OU College of Pharmacy is a contracted service through Oklahoma Health Care Authority. They provide pharmacy help desk service, prior authorization processing and drug utlization review activities.
Q: How many prescriptions am I allowed each month?
Adults have coverage for up to six (6) prescriptions each month beginning 1-1-04. From those 6 prescriptions, there is a limit of three (3) brand name products. Adults in the Home and Community Based Waiver programs such as the Advantage or DDSD waivers are eligible to receive an additional seven (7) generic prescriptions each month. Waiver patients who require more than 3 brand name drugs and/or more than a total of 13 drugs may petition for coverage of additional medications through the Medication Therapy Management Services Referral Form. Certain medications do not count against the prescription limit including anti-retrovirals used to treat HIV/AIDS, anti-neoplastic chemotherapeutic agents, drugs for which frequent laboratory testing must be performed, and both prescription and non-prescription contraceptives.
Q: How do I get Prior Authorization for my prescriptions?
Pharmacies that are contracted with Oklahoma Medicaid may fill out a Universal Petition for Medication Authorization. If a medication requires an authorization the pharmacy should complete the pharmacy section and forward to the physician for additional required information.
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Q: How long does the Prior Authorization process take?
A: Prior Authorizations are reviewed and the decision is sent back to the pharmacy within 24 hours of received time.
Q: My pharmacy requested a Prior Authorization and it has been denied. What should I do?
A: All denial information is sent back to your pharmacy including a message regarding the reason for denial. If there is an issue that needs to be discussed the pharmacy should call the pharmacy help desk.
Q: My pharmacy requested a Prior Authorization but say they haven’t received a response.
A: The pharmacy should call the pharmacy help desk to check the status if it has been more than 24 hours from the time they sent the Universal Petition.
Q: I received eligibility today and the caseworker says I have prescription benefits, but the pharmacy can’t run my claims.
A: Eligibility must have time to be updated in the computer systems. If it has been more than two weeks you can contact your OKDHS county office caseworker.
Q: I have a newborn needing a prescription. Can the pharmacy run the prescription on my card?
A: No. Each individual needs to have their own card and unique identification number. Please contact your OKDHS county office caseworker.
Q: The pharmacy said my eligibility shows other insurance, but I do not have any other coverage.
A: You should contact Third Party Liability (800) 522-0114, option 7.
Q: My pharmacy says they cannot bill my prescription on Medicaid because they cannot bill Medicare.
A: If a client has Medicare and Medicaid there are certain drugs that have to be billed to Medicare as primary. If the pharmacy does not have a contract with Medicare they will not be reimbursed on these drugs by Medicaid. You will need to find a pharmacy that is contracted with both agencies.
Q: How much are my co-payments?
A: If the cost of your prescription is less than $29.99 the co-pay is $1.00. If the cost is 30.00 and over the co-pay is $2.00.
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