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Pharmacy Services

Ensuring Access to Safe and Effective Medications: At Nebraska Total Care we are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Nebraska Total Care members. With our partners, we provide innovative and tailored pharmacy solutions, improving member health outcomes by ensuring access to essential medications, cost effective treatments and personalized clinical programs.

Heritage Health - Nebraska Total Care

Pharmacy Policies

Clinical Programs and Medication Adherence

Nebraska Total Care offers tailored clinical programs that are customized to drive medication adherence and reduce medication errors. These programs are designed to improve health outcomes by supporting members in managing chronic conditions and ensuring they receive the right medications at the right time to get and stay healthy.

Medication Therapy Management (MTM): Our MTM programs support members in understanding and managing their medications, helping to optimize their health regimens and improve therapeutic outcomes.

Medication Coverage and Cost Optimization

Our Pharmacy program uses a large network to give members access to many types of pharmacies, including retail, mail-order, and specialty pharmacies. This makes it easy for members to get their medications. We work closely with our pharmacy programs to make sure the needs of our Nebraska Total Care members are met. Nebraska Total Care covers certain prescription drugs and over-the-counter drugs when prescribed by a Nebraska Total Care provider. The pharmacy program does not cover all drugs. Some require prior authorization. Some drugs have limitations on age, dosage or maximum quantities.

The Nebraska Medicaid Preferred Drug List (PDL) is the list of drugs covered by Nebraska Medicaid. Nebraska Total Care asks that doctors prescribe medications from the Nebraska Medicaid PDL for Nebraska Medicaid patients. Some drugs will a prior approval request before the medication can be given to the member at the pharmacy. These drugs are on the prior approval list.

The Nebraska Total Care Value-Add Formulary is the list of drugs covered by Nebraska Total Care that are not on the Nebraska Medicaid PDL.
 
Nebraska Total Care members can get up to a 90-day prescription fill on maintenance medications. Maintenance medications are used to treat chronic, long-term conditions or illnesses.
 

 

Drug Look-Up Tool

Search the list of FDA-approved drugs and coverage.

Prescription Drug Monitoring Program (PDMP)

Each provider prescribing a controlled substance in Nebraska to a Medicaid client must check the prescription drug monitoring program (PDMP) established under Neb. Rev. Stat. Sec. 71- 2454 before prescribing schedule II medication and at dosage adjustment.

Specialty Pharmacy Services

Access to Specialty Medications: Through our specialty pharmacy services, we offer support for high-cost medications and complex therapies, ensuring members have access to the treatments they need with the guidance of a dedicated pharmacy team.

Any pharmacy that is licensed and in good standing with Nebraska Medicaid and accepts the terms of the pharmacy benefit manager agreement and specialty amendment will be accepted in the Nebraska Total Care specialty pharmacy network.

Hemophilia specialty drugs must be filled by a pharmacy in the hemophilia specialty pharmacy network.

Pharmacy Claim Processing

Express Scripts® is the pharmacy benefits manager for Nebraska Total Care.

Please use the following information when submitting claims for Nebraska Total Care members.

BIN: 003858
PCN: MA
GROUP: 2ETA

If you need a member’s specific prescription processing information or other help with a claim, please visit the ESI Pharmacist Resource Center. If you still need assistance processing a claim, please call the Pharmacy Help Desk at 1-833-750-4471.

Current maximum allowable cost (MAC) pricing information for all products can be found on the ESI Pharmacist Resource Center.

Electronic Prior Authorization Submissions

Submit your prior authorization (PA) requests electronically through our preferred solution CoverMyMeds. Electronic prior authorization (ePA) automates the PA process making it a quick and simple way to complete PA requests. The ePA process is HIPAA compliant and enables faster determinations. You may also use this link to track ePA requests.

Prior Authorization

Prior Authorization Medical Necessity (PDF) (April 27, 2022)

Preferred Diabetic Products

Accu-Chek Glucose Meter Provider Flyer (PDF)

Learn More

Get in Touch: For more information, contact Nebraska Total Care at 1-844-385-2192 TTY: 711.