About Your Medications
If you are a Medicare member, please check our Medicare section for information on your benefits.
Under the Affordable Care Act (ACA), health plans must cover preventive services that are recommended by the U.S. Preventive Services Task Force (USPSTF), as a Grade ”A” or “B” Recommendation, without any out-of-pocket cost to members.
In compliance with the ACA, Capital Health Plan offers this coverage to all Commercial members.
Capital Health Plan encourages the use of generics as the first-line of treatment. Generic medications are the lowest-cost options to our members and are available at a Tier 1 copay. Talk with your doctor to see if a generic is available to treat your condition.
Your Prescription Drug Benefit may be subject to limitations and exclusions such as those listed below. For a complete list, refer to your Pharmacy Program Prescription Drug Endorsement.
Use this searchable online index to locate your prescriptions and your associated copayment. The copayment amount is determined by the type of prescription drug dispensed (generic, preferred brand, non-preferred brand, self-injectable or specialty drug).
You, your authorized representative, or your prescribing physician can request an exception to prescription drug coverage restrictions or quantity limits. For example, certain drugs on CHP's formulary have quantity limits. If your drug has a quantity limit, you can ask CHP to cover a quantity over the stated limit. You may need to meet certain clinical criteria to receive an approval for the higher quantity.
Capital Health Plan contracts with pharmacies nationwide.
Each covered prescription drug, when purchased from a participating pharmacy, is subject to a copayment amount.
Beginning January 1, 2014, Capital Health Plan will utilize Prime Therapeutics to administer our pharmacy benefits.
PrimeMail is your new home delivery pharmacy service offered through Capital Health Plan. If you take long-term medicine, you can fill your prescriptions through PrimeMail.