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 from an 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.
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 are usually only ordered through a specialty pharmacy.
If you are unsure whether your current medication is a specialty drug, please review our Specialty Pharmacy Program. It has a list of specialty drugs, plus more information about them.
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 (TYY: 711).
Can I Get a Prescription with More Than a 30-day Supply?
As a general rule, Iowa Total Care members are allowed 31- day supply with the exception of birth control. Iowa Total Care members are allowed a 3 month supply of birth control.
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.