Pharmacy
Nebraska Medicaid Preferred Drug List
The medications on the Nebraska Medicaid Preferred Drug List (PDL) are covered by Nebraska Total Care. Non preferred drugs on this list may be covered when certain requirements are met. Other limitations for specific drugs may exist and are explained in the Nebraska Medicaid Claims Limitations (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. Current maximum allowable cost (MAC) pricing information can be found on the RxAdvance Pharmacy Portal.
- Nebraska Medicaid Claim Limitations (PDF) (April 1, 2021)
- Nebraska Total Care Value-Add Formulary (PDF) (April 1, 2021)
- Nebraska Total Care Over-the-Counter Approved Products (Excel) (March 26, 2021)
- Nebraska Total Care Machine Readable Formulary (JSON)
- Nebraska Medicaid Preferred Drug List PDL (April 1, 2021)
- Nebraska Medicaid MAC Price Listing (PDF) (updated monthly)
- Nebraska Total Care 90-Day Maintenance Drugs (Excel) (December 16, 2020)
- Pharmacy Update: Heritage Health Adult Expansion Program (PDF) (October 1, 2020)
- RxAdvance MAC Appeals Pharmacy Portal Guide (PDF)
- RxAdvance Pharmacy Portal
- Prior Authorization Medical Necessity (PDF)
- Buprenorphine Consent (PDF)
- Buprenorphine/Naloxone Prior Auth (PDF)
- CoverMyMeds Prior Auth Request
- Growth Hormone Prior Auth (PDF)
- Hepatitis C Prior Auth (PDF)
- Hereditary Angioedema (HAE) Prior Auth (PDF)
- Quantity Limit or High Dose Override Prior Auth (PDF)
- Synagis Prior Auth (PDF)
- Nebraska Total Care Specialty Pharmacies (PDF) (February 4, 2021)
- Nebraska Total Care Hemophilia Pharmacies (PDF) (February 4, 2021)
- Nebraska Total Care Specialty Medication Drug List (PDF) (March 4, 2021)
- Nebraska Tobacco Quitline Fax Referral Instructions (PDF) (August 1, 2020)
- Nebraska Tobacco Quitline Fax Referral Form (PDF) (January 1, 2021)
- 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 (Relay 711)