Pharmacy
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 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 Total Care Over-the-Counter Approved Products (Excel) (updated 4/1/2019)
- Nebraska Medicaid Preferred Drug List (PDL) (PDF) (updated 8/12020)
- Nebraska Medicaid Claim Limitations (PDF) (updated 8/1/2020)
- Nebraska Medicaid MAC Price Listing (PDF) (updated monthly)
- Nebraska Medicaid Pharmacy Reference Guide (PDF)
- Nebraska Total Care Value-Add Formulary (PDF) (updated 5/1/2020)
- Nebraska Total Care 90-Day Maintenance Drugs (Excel) (updated 04/01/2020)
- RxAdvance Pharmacy Claims Update (PDF) (effective 04/01/2019)
- RxAdvance MAC Appeals Pharmacy Portal Guide (PDF)
- RxAdvance Pharmacy Portal
- Prior Authorization Form (PDF)
- Prior Authorization Fax Number Change update (PDF) (effective 04/01/19)
- 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 (IGF) 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) (updated 3/29/2019)
- Nebraska Total Care Hemophilia Pharmacies (PDF) (updated 3/29/2019)
- Nebraska Total Care Specialty Medication Drug List (PDF) (updated 4/1/2019)
- Prior Authorization Medical Necessity (PDF)
- Nebraska Tobacco Quitline Fax Referral Instructions (PDF) (effective 8/1/2020)
- Nebraska Tobacco Quitline Fax Referral Form (PDF) (effective 8/1/2020)
- 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