Medicaid Pharmacy Benefits
Do not wait until you are out of a medication to request a refill. Call your doctor or pharmacy a few days before you run out.
Nebraska Total Care provides a wide variety of drugs and pharmacy benefits to members. Below you can find more information about pharmacy benefits offered by Nebraska Total Care, including information about which drugs are covered, how to get medications, and more.
90-Day Maintenance Drugs
Nebraska Total Care members are able to get up to a 90-day prescription fill on maintenance medications. Maintenance medications are used to treat chronic, long-term conditions or illnesses. Nebraska Total Care has a list of 90-Day Maintenance Drugs (Excel).
Nebraska Total Care covers certain prescriptions and over-the-counter (OTC)* drugs when prescribed by a provider. The pharmacy program does not cover all drugs. Some require prior authorization. Some drugs have limitations on age, dosage, or maximum quantities.
You can read more detailed information about the pharmacy program on the Nebraska Total Care Value-Add Formulary (PDF). (June 1, 2023)
*Please refer to the Value-Add Formulary to see which drugs are over-the-counter (OTC).
Nebraska Total Care can cover these types of medication:
- Prescription drugs - The Preferred Drug List is a list of some of the drugs covered by Nebraska Total Care. A team of doctors and pharmacists update this regularly. They want to make sure the medication on the list is safe and helpful for you.
- Nebraska Medicaid Preferred Drug List (PDL) (PDF) (June 1, 2023)
- Drugs to help you quit smoking
- Needles, syringes, blood glucose monitors, test strips, lancets and glucose urine testing strips
- Medicaid Prescription Claim Reimbursement Form (PDF)
*Please refer to the Value-Add Formulary to see which drugs are over-the-counter (OTC).
You can have your prescriptions filled at any Nebraska Total Care network pharmacy. Show the pharmacy:
- your prescription
- your Nebraska Medicaid ID card
- your Nebraska Total Care ID card
If you need help finding a pharmacy you can use the Find A Provider tab. You can also call us at 1-844-385-2192 (TTY 711).
Nebraska Total Care 90-Day Maintenance Drugs (Excel) (April 20, 2023)
Nebraska Total Care Hemophilia Pharmacies (PDF) (December 1, 2022)
Vaccine preventable diseases have not gone away. Vaccines will help keep you healthy.
How it works:
- Locate a pharmacy. You can use the Find a Provider page or call Member Services.
- Call the pharmacy you choose and ask if they have the vaccine you need.
- Show your Nebraska Medicaid ID card and Nebraska Total Care ID card.
- Get your vaccination.
No appointment, no copays, no hassle.
Covered vaccines include:
- Seasonal Influenza Vaccine
- Intradermal Influenza Vaccine (Short Needle)
- High-Dose Seasonal Influenza Vaccine (Fluzone)
- Zoster (Zostavax)
- Pneumonia
- Meningococcal
- Human Papillomavirus (HPV)
- Tetanus/Diphtheria/Pertussis
- Covid-19
For more information call Member Services at 1-844-385-2192 (TTY 711).
Search Krames Staywell Health Library to get answers to your drug questions.
Copays
Many Medicaid members never have a copay. These members are:
- Eighteen years old or younger
- Pregnant, and for 60 days after the pregnancy ends
- In an inpatient hospital
- In a long term care facility
- In a facility where they have to spend most of their income for medical cost
- Living in a residential facility, adult family home, or center for the developmentally disabled
- Native Americans getting services from an Indian Health Center
- Native Americans getting services referred by an Indian Health Center
- Receiving waiver services under a 1915(c) waiver
- Get help from the State Disability Program
You can see the Preferred Drug List (PDL) on this page or we can send it to you. Medications for family planning (birth control) never have a copay. There are some Medicaid members who have a copay for some brand name prescriptions. If you are eligible for a copay it will be $3.
Update May 11, 2020: Due to COVID-19 we have made a change. At this time, there are no copays for any covered meds.