It's important to SilverSummit Healthplan that our members receive drug therapy that is appropriate, high-quality and cost-effective. We work hard to ensure you have access to safe and effective medications that are medically proven to help you get healthy and stay healthy.
We will ensure you have access to safe and effective medications to help you get healthy and stay healthy. We offer an additional benefit of $30 per member household, per quarter for commonly-used over-the-counter (OTC) items not covered through the State Plan.
What Pharmacy Benefits are Covered?
SilverSummit Healthplan covers certain prescription drugs and over-the-counter drugs when prescribed by a SilverSummit Healthplan provider. The pharmacy program does not cover all drugs. Some require prior authorization. Some drugs have limitations on age, dosage or maximum quantities.
Which Drugs are Covered?
The Preferred Drug List (PDL) is the list of drugs covered by SilverSummit Healthplan. SilverSummit Healthplan 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 pharmacies or mail order. SilverSummit Healthplan's PDL is continually evaluated by the Pharmacy and Therapeutics Committee to promote the appropriate and cost-effective use of medications.
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.
Your specialty pharmacy is AcariaHealth. They can be reached at 1-800-511-5144.
How Do I Get Medications?
You can have your prescriptions filled at a network pharmacy. At the pharmacy, you will need to give the pharmacist your prescription and your SilverSummit Healthplan ID Card. If you need help finding a pharmacy near you, call us or check online.
Can I Get a Prescription With More Than a 30-day Supply?
Certain drugs are considered maintenance medications because they are used to treat long-term conditions or illnesses. If the drug you take is part of the Maintenance Drug Program, you may receive up to 100 day supply at specific retail pharmacies.
Members can also obtain a 100 day supply (3 month supply) of maintenance medications filled at one time. It’s important to know that not all of our pharmacies are able to fill a 100-day supply, so please check this list of participating pharmacies prior to taking your 3 month prescription to them.
Where Can I Get My Prescription Filled?
To find a pharmacy that is in the SilverSummit Healthplan network, you can use the Find a Provider tool. Type in your city or zip code. 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 SilverSummit Healthplan network are listed.
Enhanced OTC Benefits
- As a commitment to our members’ overall health and wellbeing, at SilverSummit Healthplan we offer an additional quarterly benefit of $30 per member household, for commonly-used over-the-counter (OTC) items not covered through SilverSummit’s Prescription Plan.
- These items will be shipped directly to your home from our pharmacy benefit manager’s mail order pharmacy, HomeScripts.
- Members may select from any items up to the $30 per quarter limit
- Items on the list include, but are not limited to: cough/cold/allergy medicines, antacids, and oral care.
- Medication and products cannot be returned once they are received by the member.
- If the order is undeliverable or unavailable members are provided a full return or replacement order.
- Remaining balances are NOT carried over to the next quarter.
- For more information please contact Homescripts at 1-866-577-9010
- Hours of availability are Monday to Friday from 8am to 8pm EST
- Please have your SilverSummit ID and Medicaid ID available when you call
- When ordering, please have the item number ready
- Orders may also be placed via the member portal on www.silversummithealthplan.com