Pharmacy
Pharmacy claims processing change
Effective April 1, 2019, Envolve™ Pharmacy Solutions will transition Nebraska Total Care claims processing to RxAdvance. The Pharmacy Update document (PDF) was distributed to pharmacy providers and includes all of the information necessary for processing claims after that date.
Pharmacy Prior Authorization Fax Number Change
Please update your fax system and your Prior Authorization systems to reflect the change in fax number to 1-877-386-4695 for requests from April 1st, 2019 forward. The contact information update document can be found on the Prior Authorization Fax Number Change update (PDF).
Nebraska Total Care is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Nebraska Total Care members. Nebraska Total Care covers prescription medications and certain over-the-counter medications with a written order from a Nebraska Total Care provider. The pharmacy program does not cover all medications. Some medications may require prior authorization and some may have limitations. Other medically necessary pharmacy services may be covered as well.
- Nebraska Medicaid Over-the-Counter Approved Products (Excel)
- Nebraska Medicaid Preferred Drug List PDL (updated monthly)
- Nebraska Total Care Medicaid Formulary List (PDF) (updated monthly)
- Nebraska DHHS Claim Limitations (PDF)
- Nebraska Medicaid MAC Price Listing (PDF)
- RxAdvance MAC Appeals Pharmacy Portal Guide (PDF)
- RxAdvance Pharmacy Portal
- Prior Authorization Form (PDF)
- Amylinomimetic Agents Prior Auth (PDF)
- Brand Only Request (PDF)
- Buprenorphine Consent (PDF)
- Buprenorphine/Naloxone Prior Auth (PDF)
- CoverMyMeds Prior Authorization Request
- Glucagon-Like Peptide-1 Receptor Agonists Prior Auth (PDF)
- Growth Hormone Prior Auth (PDF)
- Hepatitis C Prior Auth (PDF)
- Insulin-Like Growth Factor Prior Auth (PDF)
- Long-Acting Injectable (LAI) Prior Auth (PDF)
- Low/Non-Sedating Antihistamines Prior Auth (PDF)
- NSAIDs: Cox I Prior Auth (PDF)
- Proton Pump Inhibitors Prior Auth (PDF)
- Quantity Limit or High Dose Override Prior Auth (PDF)
- Synagis Prior Auth (PDF)
- Youth Psychotropic Initiative Prior Auth (PDF)
- Nebraska Total Care Specialty Pharmacies (PDF)
- Nebraska Total Care Hemophilia Pharmacies (PDF)
- Nebraska Total Care Specialty Medication Drug List (PDF)
- Prior Authorization Medical Necessity (PDF)
- Nebraska Medicaid Pharmacy Reference Guide (PDF)
- Lock-in Provider Agreement (PDF)
- Lock-in Criteria (PDF)
- Nebraska Tobacco Quitline Fax Referral Instructions (PDF)
- Nebraska Tobacco Quitline Fax Referral Form - English (PDF)
- Nebraska Tobacco Quitline Fax Referral Form - Spanish (PDF)
- Nebraska Tobacco Quitline Flow Chart (PDF)
- Nebraska Smoking Cessation Benefits (PDF)
Contact Us
RxAdvance Help Desk
Phone: 1-800-974-5268
Envolve™ Pharmacy Solutions
Prior Auth Phone: 1-844-330-7852
Prior Auth Fax: 1-877-386-4695
Nebraska Total Care
Phone: 1-844-385-2192, Nebraska Relay Service 711