Your Child’s Medicines

Keystone First - CHIP covers medicines that are:

• Medically necessary.
• Approved by the U.S. Food and Drug Administration (FDA).
• Prescribed by your child’s health care provider.

When a provider prescribes a medication for your child, you can take it to any pharmacy that is in Keystone First - CHIP’s network. You will need to have your child’s Keystone First - CHIP ID card with you, and your child may have a co-payment. Keystone First - CHIP will pay for any medicine listed on Keystone First - CHIP’s drug formulary and may pay for other medicines if they are prior authorized. Either your child’s prescription or the label on your child’s medicine will tell you if your child’s doctor ordered refills of the prescription and how many refills you child may get. If your child’s doctor ordered refills, your child may only get one refill at a time. If you have questions about whether a prescription medicine is covered, need help finding a pharmacy in Keystone First - CHIP’s network, or have any other questions, please call Enrollee Services at 1-844-472-2447 (TTY 711).

Drug Formulary

A formulary, also called a preferred drug list (PDL), is a list of medicines that Keystone First - CHIP covers. This is what your child’s PCP or other doctor should use when deciding what medicine your chid should take. The formulary has both brand name and generic drugs. Generic drugs contain the same active ingredients as brand name drugs. Any medicine prescribed by your child’s doctor that is not on Keystone First - CHIP’s formulary needs prior authorization. The formulary can change from time to time, so you should make sure that your child’s provider has the latest information when prescribing a medicine for your child. If you have any questions or to get a copy of the drug formulary, call Enrollee Services at 1-844-472-2447 (TTY 711).

Specialty Medicines

The drug formulary includes medicines that are called specialty medicines. A prescription for these medicines needs prior authorization. To see the drug formulary and a complete list of specialty medicines, call Enrollee Services at 1-844-472-2447 (TTY 711). You will need to obtain these medicines from a specialty pharmacy. A specialty pharmacy can mail your child’s medicines directly to your home at no cost to you for the mailing and will contact you before sending them. You may have a co-payment for your child’s medicine. The pharmacy can also answer any questions you have about the process. You can pick any specialty pharmacy that is in Keystone First - CHIP’s network. For the list of network specialty pharmacies, please call Enrollee Services at 1-844-472-2447 (TTY 711) or see the provider directory.

Over-the-Counter Medicines

Keystone First - CHIP covers some over-the-counter medicines when the drug is part of the formulary. You must have a prescription from your child’s provider for these medicines for Keystone First - CHIP to pay for them and a documented medical condition that indicates that the drug is medically necessary. You will need to have your child’s Keystone First - CHIP ID card with you, and your child may have a co-payment. The following are some examples of covered over-the- counter medicines:

• Sinus and allergy medicine
• Aspirin
• Vitamins
• Cough medicine
• Heartburn medicine