Pharmacy Services

Access to Safe and Effective Medications

At 'Ohana Health Plan, our goal is to provide the right drug coverage for our members. We work closely with providers and pharmacists to make sure we offer medications that treat a range of conditions and illnesses. We are proud to work with partners who help us provide innovative and personalized pharmacy solutions. These partnerships help improve member health and make treatments more affordable. They also make sure you have access to important medications and get the support you need through personalized clinical programs.

Clinical Programs and Medication Adherence

'Ohana Health Plan offers special programs that help you stick to your medications and avoid mistakes. These programs are designed to improve your health. We support you in managing long-term conditions and make sure you get the right medications at the right time to stay healthy. 

Medication Therapy Management (MTM)

Our MTM programs help members understand and manage their medications. We work with you to improve your healthcare routine and get the best results from your treatments.

Medication Coverage and Cost Optimization

We have a large network to give members access to many types of pharmacies, including retail, mail-order, and specialty pharmacies. This makes it easy for you to get your medications. We work closely with our pharmacy programs to make sure they meet your needs as an 'Ohana Health Plan member.

'Ohana Health Plan covers certain prescription drugs and over-the-counter (OTC) drugs when prescribed by an 'Ohana Health Plan provider. We do not cover all drugs. Some need prior authorization. Some drugs have limits on age, dosage or quantities.

The Preferred Drug List (PDL) is the list of drugs covered by 'Ohana Health Plan. 'Ohana Health Plan asks that doctors prescribe medications from the 'Ohana Health Plan preferred drug list for their patients who are members of 'Ohana Health Plan. Some drugs will need your doctor to ask for prior approval before the medication can be given to you at the pharmacy. These drugs are on the prior approval list.

View CCS Pharamacy Services page

Drug Look-Up Tool

Search the list of FDA-approved drugs and coverage: Search NowExternal Link

Helpful Documents:

If a prescription you take is no longer preferred, you will be told by your doctor, Managed Care Plan, or pharmacy. You may need to switch to a different medication. You can also ask your doctor to ask for a prior authorization to stay on your current medication. If you get a letter in the mail from 'Ohana Health Plan, please read it carefully. You should talk to your doctor about it at your next visit or call your doctor’s office. If you try to refill your prescription before your next visit, the pharmacy may tell you that your medication needs prior authorization. We will work with your doctor to make sure you get the medication you need. You will not lose drug coverage. You will keep using the same Medicaid ID.

If you have questions or problems with your prescription, call 'Ohana Health Plan member services by dialing the toll-free number 1-888-846-4262 (TTY 711) on your Medicaid ID card or 1-866-401-7540 (TTY 711) on your CCS ID card.

Specialty Pharmacy Services

What is a Specialty Medication?

A specialty drug is a prescription drug that needs special handling, administration, or supervising. These are often only ordered through a specialty pharmacy.

What is a Specialty Pharmacy?

A specialty pharmacy provides services and medications needed to treat members with chronic, complex or rare conditions. The medication provided by specialty pharmacies is often considered high-touch or high-cost. The services provided by specialty pharmacies are done by highly trained professionals and are more extensive than regular retail pharmacies offer. Specialty pharmacy services can include clinical help, such as training on how to take medication, and financial support, like applying for copay assistance.

Access to Specialty Medications

Through our specialty pharmacy services, we offer support for high-cost medications and complex therapies. We make sure members have access to the treatments you need with the guidance of a dedicated pharmacy team.

AcariaHealth is Your Preferred Specialty Pharmacy

AcariaHealth is a national specialty pharmacy dedicated to transforming lives with compassionate care. They focus on enhancing the health and outcomes of people with complex medical conditions. AcariaHealth takes a collaborative approach to care. They work closely with you and your healthcare providers to tailor treatment programs to meet your unique needs.

Contact AcariaHealth

Learn more about AcariaHealth at AcariaHealth.comExternal Link. 

AcariaHealth is your preferred specialty pharmacy provider. Members can ask that any willing specialty pharmacy provider of their choosing fill their prescriptions.

Fill and Receive Your Prescriptions

You can have your prescriptions filled at a network pharmacy. At the pharmacy, you will need to give the pharmacist your prescription and your 'Ohana Health Plan ID Card.

To find a pharmacy that is in the 'Ohana Health Plan network, you can use the Find a Provider Tool. Type in your city or zip code. Then click Select Your Plan. Select your plan or network and click Continue. Type in the name of your pharmacy and click Search. You can also select Pharmacy & Medical Supplies in the Choose a Category area. This will show a list of pharmacies in the 'Ohana Health Plan network.

Pharmacy Services

We work closely with our pharmacy partners to create solutions that fit the needs of doctors and patients. This approach enhances care coordination, improves clinical outcomes, lowers risks, fostering collaboration that drives better patient satisfaction and care delivery.

Over the Counter (OTC) Medications

'Ohana Health Plan offers an added monthly benefit that covers $10 per member household, for commonly-used over-the-counter (OTC) items not covered through 'Ohana Health Plan’s Prescription Plan.

Members may select from any items up to the $10 per month limitItems on the list include, but are not limited to: cough, cold, and allergy medicines, antacids, and oral care. The OTC Catalog can be found on the plan overview page.Members cannot return medication and products once received If the order is not deliverable or not available members are given a full return or replacement orderBalances carry over to the next month and remain available through the end of the calendar year

Please have your 'Ohana Health Plan ID and Medicaid ID available when you call 1-888-846-4262 (TTY 711) or order through our member portal. After you log in, click on “Over-the-Counter (OTC) Items.” When ordering, please have the item number ready.

Mail-Order Service

'Ohana Health Plan offers a mail-order pharmacy service. It allows members to receive up to a 100-day supply of certain generic maintenance medications delivered to their door, saving them time and money. This service increases medication adherence while offering significant cost savings.

Learn More

Get in Touch: For more information, contact us toll-free at: 1-888-846-4262 (TTY 711) for QUEST members or 1-866-401-7540 (TTY 711) for CCS members