Medicaid : Pharmacy Information

‘Ohana Health Plan covers medically necessary drugs that are required by Medicaid. It is also important to know we use a Preferred Drug List (PDL). These are the drugs that we prefer that your doctor prescribe. Most PDL drugs are covered without a Drug Evaluation Review (DER). Some PDL drugs require a DER and these are noted with a “PA” (prior authorization). There are also some drugs on the PDL that require step therapy or the use of other drugs before they will be approved. They are noted on the PDL with a “ST” (step therapy).

The PDL 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 DER Request Form for the following:

Drugs not listed on the PDL
Drugs listed on the PDL with a prior authorization
Most self-injectable and infusion drugs
Brand drugs when generic drugs are available
Drugs that exceed the Food and Drug Administration (FDA) daily or monthly quantity limits
Drugs with a step therapy