Quick Reference - Pharmacy Benefits
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- Download Getting the Most from Your Pharmacy Benefits (English/Spanish) as a PDF.
Getting the Most From Your DDD-ALTCS Pharmacy Benefits
Understanding how all your insurance benefits work together.
If you have more than one insurance plan, make sure to give all your insurance cards to the pharmacy staff to save time and hassle when picking up prescriptions.
Why?
When a pharmacy has all your insurance cards, it may be able to coordinate benefits between the different insurance plans.
Prescriptions must be billed to your private insurance first. DDD members eligible for Medicaid coverage through the Arizona Long Term Care System (ALTCS) may cover other costs like copays or coinsurance.
For questions about benefits, contact your DDD Health Plan’s Member Services.
Examples of Primary Insurance
- Private insurance, like through a guardian’s or parent’s employer prescription insurance
- Military coverage through TRICARE
- Medicare
If you have Medicare Part D or Medicare Advantage plan, Medicare copays or coinsurance amounts are not covered under Medicaid. Medicaid may pay for Over-The-Counter (OTC) items not covered by your Medicare Part D or Medicare Advantage Plan.
What can I do if I cannot get a prescription?
- Contact your private insurance Member Services for help.
- Ask your pharmacist to call the Health Plan’s Pharmacy Help Desk.
- Call the Member Services of your DDD Health Plan or the DDD Tribal Health Program.
- Contact your DDD Support Coordinator.
The member or their healthcare representative may only speak to Medicare. DDD staff will help you find the right number for Medicare to call if you need it.
There are many reasons why a prescription may not be covered. The most common reason is that the medication requires prior authorization. If you had an approval for a medication in the past, the approval may have only been good for 6 months or a year. If you need a refill, it will require review again. Ask your doctor to send the prior authorization request and any supporting medical documents to your insurance. If you need help, contact your Health Plan’s Member Services or your DDD Support Coordinator.