CeltiCare is committed to providing appropriate, high quality, and cost effective drug therapy to all CeltiCare members. CeltiCare works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. CeltiCare covers prescription medications and certain over-the-counter medications when ordered by a CeltiCare provider. The pharmacy program does not cover all medications. Some require prior authorization or have limitations on age, dosage, and maximum quantities.

Preferred Drug List

The CeltiCare Preferred Drug List (PDL) is the list of covered drugs. The CeltiCare PDL is continually evaluated by the CeltiCare Pharmacy and Therapeutics Committee to promote the appropriate and cost-effective use of medications.

Prior Authorization

Some medications listed on the CeltiCare PDL may require prior authorization. All reviews are performed by a licensed clinical pharmacist using the criteria established by the CeltiCare P&T Committee. If CeltiCare does not grant prior authorization we will notify you and your patient and provide information regarding the appeal process.

Pharmacy Benefit Manager

CeltiCare works with US Script to deliver safe and cost effective therapeutics to cost effective medications to our members. We also work together to administer the prior authorization process. Certain drugs may require prior authorization prior to dispensing. Please refer to the Preferred Drug Listing on this site for additional information.

Specialty Pharmacy Provider

Caremark is CeltiCare’s preferred Biopharmaceutical and Specialty Injectibles provider. Providers can request delivery of specific biopharmaceuticals and specialty injectibles to their office or to the member by contacting Caremark at (800) 237-2726 or fax the Caremark Enrollment form to (800) 323-2445 for prior authorization. Caremark will contact the provider or member for deliver confirmation.