Pharmacy Services
'Ohana Health Plan covers drugs considered medically necessary by Medicaid.
We use a list of drugs that we prefer your doctor prescribe called the Preferred Drug List (PDL).
Most of these medications are covered without a Coverage Determination Request. But, some of these drugs do require a review and are noted with a PA (Prior Authorization).
Some drugs require step therapy – the use of other drugs first before they will be approved. These are noted with an ST (Step Therapy).
The list will also have drugs that may have limits due to your age or the quantity prescribed. These are noted on the PDL with an AL (Age Limit) and QL (Quantity Limit).
Your doctor will need to submit a Coverage Determination Request for the following:
- Drugs not on the PDL
- Drugs with a PA on the PDL
Always show your 'Ohana ID Card at the pharmacy.
- Medicaid-only members should not have to pay co-pays for drugs on 'Ohana's Preferred Drug List (PDL). But there may be times when you have to pay for covered drugs.
- This can happen if you forget to show your 'Ohana ID card at the pharmacy.
- If you do pay out of pocket for covered drugs, you can ask for a refund. Just fill out a Direct Member Reimbursement Request Form and send it to 'Ohana.
Printed Preferred Drug ListsI
- 'Ohana QUEST Integration Preferred Drug List (PDF)
- 'Ohana QUEST Integration Machine Readable File
- 'Ohana QUEST Integration Dual Eligible Preferred Drug List (PDF)
- 'Ohana QUEST Integration Notice of Change (PDF)