Providers

Drug Coverage Information

iCare Medicaid SSI and BadgerCare Plus Core Drug Coverage

The pharmacy benefit for members of iCare Medicaid SSI and BadgerCare Plus is managed by the state of Wisconsin.  Please call the state provider services line at 1-800-947-9627 for information regarding drug coverage.

iCare Medicare Plan and iCare Family Care Partnership Drug Coverage

The pharmacy benefits for iCare Medicare Plan and iCare Family Care Partnership are managed by iCare.  Each plan utilizes a formulary approved by CMS which includes both brand and generic medications.  For certain medications, there are additional requirements for coverage or limits on the coverage.  These are indicated within the formulary as PA (Prior Authorization), ST (Step Therapy), or QL (Quantity Limit).  A list of our covered drugs, as well as descriptions of the additional requirements or limits on the coverage can be found within the Comprehensive Formularies below.  Details regarding prior authorization requirements or step therapy criteria are also posted on this page. 

Medicare
2011 iCare Medicare Comprehensive Formulary
2012 iCare Medicare Comprehensive Formulary

Family Care Partnership
2011 iCare Partnership Comprehensive Formulary
2012 iCare Partnership Comprehensive Formulary

Notice of Formulary Changes

The formularies may change slightly during the year as new drugs become available or new information is released regarding a drug’s safety or efficacy.  In most cases, CMS requires that we notify all authorized prescribers and pharmacists 60 days prior to removing a covered Part D drug from our formulary or changing the preferred status of a covered Part D drug.  Please look at the applicable Formulary Change Notice below for details regarding changes that will occur or have occurred to our formularies this year.
Formulary Change Notice (iCare Medicare Plan)
Formulary Change Notice (iCare Partnership)

Requesting Prior Authorization or a Formulary Exception

As indicated within the formulary, a Prior Authorization is required on certain medications before they will be covered.  Links to the Prior Authorization forms are located below.  We have also provided additional details regarding prior authorization requirements and step therapy criteria.

When the medications on our formulary used to treat a specific condition are not appropriate for a patient, you may request coverage of a non-formulary medication.  This type of request is called a Formulary Exception.   An exception may also be requested to the Step Therapy criteria when first-line agents are not appropriate for your patient, or to the Quantity Limit restrictions when the allowed quantity is not enough to adequately treat your patient’s condition.  The Prior Authorization forms located below may be used for formulary exceptions as well.  Supporting medical information must be submitted with any exception request.  The requests should be faxed to our Pharmacy Benefits Manager, MedImpact, at 858-790-7100.

Or, you may click here to submit a prior authorization through the web. You will be redirected to MedImpact's website.

Medicare Part D Coverage Determination Form
Medicare Part D Coverage Redetermination Form
Medication Request Form - Partnership Medicaid

2011 Prior Authorization Criteria iCare Medicare
2011 Prior Authorization Criteria iCare Partnership

2011 Step Therapy Criteria iCare Medicare
2012 Step Therapy Criteria iCare Medicare

2011 Step Therapy Criteria iCare Partnership
2012 Step Therapy Criteria iCare Partnership


Medication Therapy Management Program

A Medication Therapy Management (MTM) program is a program that may be furnished by a pharmacist and is designed to assure that the drugs of Medicare beneficiaries are appropriately used to optimize therapeutic outcomes and to reduce adverse drug events.

MTM programs target members who have multiple chronic diseases, are taking multiple Part D drugs, and are likely to incur annual costs for covered Part D drugs that exceed a specified level. 

iCare has contracted with Outcomes Pharmaceutical Health Care© (Outcomes) to provide MTM services to a subset of our Medicare members.  Outcomes has a network of specially trained personal pharmacists that provide MTM services in the community pharmacy setting.  As part of the MTM program, each MTM-eligible member is invited to participate in an annual face-to-face consultation with a personal pharmacist to review and organize the member’s medication usage and identify, resolve, and/or prevent medication-related problems.  In addition, MTM-eligible members also receive quarterly Targeted Medication Reviews to assess medication use since the annual medication review, monitor whether any unresolved issues need attention, or identify other new potential drug therapy problems.  Issues identified during medication reviews may require the pharmacist to contact the prescriber for resolution.  If you have questions regarding the program or your patient’s participation in the program, please feel free to contact iCare’s Pharmacy Services Department.  You can also visit the Outcomes website at www.getoutcomes.com for additional information.


Electronic Prescribing

iCare supports electronic prescribing for our Medicare members through Surescripts, an e-prescribing network.  Our e-prescribing program can provide you with prescription eligibility information, basic formulary information, and patient medication histories at the point of care.  You can securely access the information using standalone e-prescribing software or an Electronic Medical Record (EMR) that has been certified by Surescripts. Visit www.surescripts.com for more information.

Network Pharmacies

We have included a list of our local network pharmacies and their telephone numbers for your convenience.

2011 Pharmacy Listing iCare Medicare Plan
2012 Pharmacy Listing iCare Medicare Plan

2011 Pharmacy Listing iCare Partnership
2012 Pharmacy Listing iCare Partnership

 

  
 
More Forms & Publications

Call 1-800-777-4376 (TTY: 1-800-947-3529), from 8:00 a.m to 8:00 p.m.,
7 days-a-week, for further information about iCare.

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