Iowa Medicaid Pharmacy Benefits and Coverage
Explore the benefits offered by Iowa Total Care
Iowa Total Care covers most prescription medications for our Iowa Medicaid members. Some prescriptions require prior authorization and may have limitations based on age or the amount of medicine prescribed. Iowa Total Care also covers certain over-the-counter medications with a prescription froman Iowa Total Care provider.
If you have questions about which drugs or prescriptions are covered by your Medicaid plan, we lay out your Iowa Medicaid prescription drug coverage below and how to find a pharmacy within the Iowa Medicaid network.
What Iowa Medicaid Pharmacy benefits are covered?
Iowa Total Care covers certain prescription drugs and over-the-counter drugs when prescribed by an Iowa Total Care provider. The pharmacy program does not cover all drugs, however. Some drugs require prior authorization and may have limitations on age, dosage or maximum quantities.
Some maintenance medications are also able to be “automatically refilled” if your pharmacy offers that service. This means that once enough days have passed and you could be close to running out of your medicine, your pharmacy will be able to get a refill ready for you without you having to ask for it. Ask your pharmacy if your medicines can be automatically refilled.
Which drugs are covered by our Iowa Medicaid Plan?
The Preferred Drug List (PDL) is the list of drugs covered by Iowa Total Care. Iowa Total Care works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. The PDL applies to drugs you receive at retail or mail order pharmacies. Iowa Total Care's PDL, which is the same as the state's PDL, is continually evaluated by the Pharmacy and Therapeutics Committee to promote the appropriate and cost-effective use of medications.
To view the Preferred Drug List, visit the Manuals and Forms page.
You can request a copy of the PDL by calling Member Services at 1-833-404-1061 (TTY: 711).
What is Iowa Medicaid Specialty Pharmacy Coverage?
A specialty drug is a prescription drug that requires special handling, administration, or monitoring. These can be ordered through a specialty pharmacy.
How do I get medications?
You can have your prescriptions filled at a pharmacy in the Iowa Total Care network. At the pharmacy, you will need to give the pharmacist your prescription and your Iowa Total Care ID Card. If you need help finding a pharmacy near you, call us at 1-833-404-1061 (TTY: 711).
How many days worth of medicine can I get at a time?
Iowa Total Care has many generic maintenance medications that are filled for 90 days at a time. These include birth control and medicines that can treat chronic health conditions, like high blood pressure and high cholesterol. Most other medications that you take regularly can be filled for up to 31 days at a time. For some medications, a shorter days’ supply is required if the medication is new for you. For more information, you can visit the Iowa Medicaid PDL page or ask your doctor or pharmacist.
Where can I get my prescription filled?
To find a pharmacy that is in the Iowa Total Care network, you can use the Find a Doctor tool.
Type in your city or zip code into the Find a Doctor search bar. Then click Update.
Choose Other and type the name of your pharmacy.
You can also select the pharmacy type in the Select Specialty area. Only those pharmacies in the Iowa Total Care network are listed.