Prescription Drug Coverage
The PACE program provides prescription drugs and certain over-the counter medications for all members. Your care team works with you and your physician to be sure you are taking the right medications to meet your needs. Your team reviews your medications periodically and makes certain that medications can be taken together safely.
If you have Medicare, your prescription drug coverage is through Medicare Part D. If you have Medicaid only, your prescription drug coverage is through Wisconsin Medicaid. All PACE members have the same prescription drug coverage and benefits.
The formulary explains what prescription drugs are covered by the plan. It also tells you if there are any rules that limit coverage of a drug. Lastly, it includes the over-the-counter medications that are covered by Medicaid when ordered by a physician or nurse practitioner.
PACE Formulary -List of Covered Drugs
Some covered drugs have limits or conditions for coverage. The following documents explain the limits and conditions:
PACE must approve these drugs before you fill your prescriptions. If you don't get approval, we may not cover the drug.
- Prior Authorization - Prior Authorization Criteria - We must approve these drugs before you fill your prescriptions. If you don’t get approval, we may not cover the drug
- Step Therapy - We require you to first try certain drugs to treat your medical condition before we will cover another drug for your condition.
Part D Formulary Transition Policy tells you how we will help if your current prescription drug is not on the Community Care formulary or if it is taken off of the formulary after you have become a member.
Pharmacy Directory
The pharmacies in our network are listed in your provider directory. In addition, you can easily find a network pharmacy in your area by using our online pharmacy directory. Please use this Pharmacy Directory introduction with your search results.
