Pharmacy

CeltiCare Health is committed to providing appropriate, high-quality, and cost-effective drug therapy to all CeltiCare Health members. CeltiCare Health covers prescription medications and certain over-the-counter medications with a written order from a CeltiCare Health provider. The pharmacy program does not cover all medications. Some medications may require prior authorization and some may have limitations. Other medically necessary pharmacy services are covered as well.

Use our Preferred Drug List to find more information on the drugs that are covered.

Prior Authorization Process FAQ’s for Providers

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

Some medications listed on the CeltiCare Health PDL may require prior authorization. All reviews are performed by a licensed clinical pharmacist using the criteria established by the CeltiCare Health P&T Committee. If CeltiCare Health does not grant prior authorization we will notify you and your patient and provide information regarding the appeal process. To request prior authorization for a medication listed on the CeltiCare Health PDL, please call US Script at (855) 678-6975, or fill out the Prior Authorization Request Form and follow the instructions provided on the document.

Specialty Prior Authorization Individual Medication Forms

CeltiCare Health works with Envolve Pharmacy Solutions 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 CeltiCare Health Preferred Drug List (PDL) for additional information.

AcariaHealth is CeltiCare Health’s exclusive bio-pharmaceutical and specialty injectables provider. Providers can request delivery of specific bio-pharmaceuticals and specialty injectables to their office or to the member by contacting AcariaHealth at (855)535-1815 or fax the Acaria Prior Authorization form to (855) 815-9894 for prior authorization. AcariaHealth will contact the provider or member for deliver confirmation.

Pharmacy and Medical Policies containing the criteria to determine the Medical Necessity of medications, diagnostic or therapeutic services, and procedures may be found by going to the Pharmacy and Medical Policy page.

If you have any further questions, please call us at: 1-855-678-6975 (TDD/TTY: 1-866-614-1949).