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Your Pharmacy Coverage

Whether or not you have pharmacy coverage depends on the plan you are enrolled in. To see your exact level of coverage, please log in to my NHP to view your health plan information.

Our pharmacy benefit covers most prescription drugs and some brand-name and generic (non-brand-name) over-the-counter drugs, with a prescription.

When available, members must use generic medicines unless your provider writes “no substitution” on the prescription, and an authorization has been approved. Keep in mind, generic medications have the same active ingredients, quality, and results as brand name drugs. They are also tested and approved by the U.S. Food and Drug Administration (FDA).

Some drugs require a prior authorization

When a prior authorization is required, the doctor must ask the health plan to cover the drug and provide medical information to back up the request before the drug will be covered. This process helps ensure the drug is being used safely. A new drug without a track record of safety may require prior authorization, for example. Your doctor can submit prior authorizations online through an electronic prior authorization tool, or he or she can fax or call in the prior authorization. Your doctor can find information about prior authorizations* in the Providers’ section of our website.​

What drugs are covered? Our Drug Lookup tool lets you know.

You can find out if your plan covers a drug by using our Drug Lookup tool. You can also call Customer Service at 1-800-462-5449 (TTY 1-800-655-1761), Monday through Friday, 8:00 a.m. to 6:00 p.m. and Thursdays, 8:00 a.m. to 8:00 p.m.

Where can I fill my prescriptions?

You may fill your prescription medicines at any pharmacy in NHP’s national network, which includes most major pharmacy chains and most local pharmacies. 

Be sure to show your NHP Member ID Card so the pharmacist will know you are a member of NHP. Some prescription drugs need an authorization. Your NHP PCP can ask us for a prior authorization so you can have the prescriptions you need.

What if I go outside of the pharmacy network?

If you choose to fill a prescription for a covered drug at a pharmacy that is not in the NHP network, you must pay the retail price for the drug and then submit a claim to be paid back. To do this, download our Prescription Drug Reimbursement Form, fill it out, and mail it with your dated drug store prescription label to:

Catamaran
P.O. Box 968021
Schaumburg, IL 60196-8021

The prescription labels must state the name of the drug, the prescription number, and the amount paid. Please keep a copy for your own records.

Our Access90 pharmacy program can save you time and money.

There is good news if you take medication on a regular basis. Access90 is an NHP program that allows you to get up to a 90-day supply of certain prescription medicines from participating pharmacies. The benefit to you:  reduced copays for a 90-day supply.
For the most up-to-date list of medications in the Access90 program, use the Drug Lookup tool. Keep in mind, the medications listed may be subject to a pharmacy step-therapy program or may require additional authorization. If you need more information, call NHP Customer Service at 1-800-462-5449 (TTY 1-800-655-1761).

Is there an Over-The-Counter (OTC) drug benefit? 

NHP members enjoy a benefit that’s rare among even the most generous pharmacy plans: An Over-The-Counter drug benefit that allows members to obtain select over-the-counter drugs, up to a 30-day supply, for a low copay cost.

To take advantage of the Over-The-Counter drug program, please remember:

  • A valid prescription is required
  • Only generic versions of a drug are covered, when available
  • The prescription must be filled at an NHP-participating pharmacy
  • Quantities may be limited to 30‐day supply.

 

*2013 NHP medication updates can be viewed here.