Pharmacy Services

Ensuring Access to Safe and Effective Medications

At 'Ohana Health Plan we are committed to providing appropriate, high-quality, and cost-effective drug therapy to all 'Ohana Health Plan members. With our partners, we provide innovative and tailored pharmacy solutions, improving member health outcomes by ensuring access to essential medications, cost effective treatments and personalized clinical programs.

Clinical Programs and Medication Adherence

'Ohana Health Plan offers tailored clinical programs that are customized to drive medication adherence and reduce medication errors. These programs are designed to improve health outcomes by supporting members in managing chronic conditions and ensuring they receive the right medications at the right time to get and stay healthy.

Medication Therapy Management (MTM)

Our MTM programs support members in understanding and managing their medications, helping to optimize their health regimens and improve therapeutic outcomes.

Medication Coverage and Cost Optimization

Our Pharmacy program uses a large network to give members access to many types of pharmacies, including retail, mail-order, and specialty pharmacies. This makes it easy for members to get their medications. We work closely with our pharmacy programs to make sure the needs of our 'Ohana Health Plan members are met. 'Ohana Health Plan covers certain prescription drugs and over-the-counter drugs when prescribed by an 'Ohana Health Plan provider. The pharmacy program does not cover all drugs. Some require prior authorization. Some drugs have limitations on age, dosage or maximum 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 require a prior approval request before the medication can be given to the member at the pharmacy. These drugs are on the prior approval list.

View QUEST (Medicaid) Pharmacy Services Page

Coverage Determination Requests 

Request a coverage decision and/or exception or file an appeal of a drug coverage decision.

Medication Appeals
You may appeal a coverage determination decision by contacting our Pharmacy Appeals Department.

Specialty Pharmacy Services

Access to Specialty Medications: Through our specialty pharmacy services, we offer support for high-cost medications and complex therapies, ensuring members have access to the treatments they 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 through compassionate care. They focus on enhancing the health and outcomes of people with complex medical conditions. AcariaHealth takes a collaborative approach to care, working closely with providers and their offices to tailor treatment programs to meet members’ unique needs.
AcariaHealth provider services include:

  • Single point of contact (Provider Experience Managers)
  • Support with referral and prior authorization processes
  • Web-based collaboration and enhanced communication

While AcariaHealth is your preferred specialty pharmacy provider, prescribers have the option to request that prescriptions be filled by any willing specialty pharmacy provider of their choosing.

How to Send a Prescription Referral

Learn more about AcariaHealth at AcariaHealth.comExternal Link.

Alternative Specialty Pharmacy Providers

Sometimes, certain medications are not available through AcariaHealth. For example, some medications are only available at other pharmacies in a limited distribution network. In these cases, we will cover medications through a different specialty pharmacy.

Learn More:

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