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 for all products can be found on the CVS Pharmacy Portal.
- Nebraska Medicaid Claim Limitations (PDF) (September 1, 2022)
- Nebraska Total Care Value-Add Formulary (PDF) (September 1, 2022)
- Nebraska Total Care Over-the-Counter Approved Products (Excel) (August 30, 2022)
- Nebraska Total Care Machine Readable Formulary (JSON)
- Nebraska Medicaid Preferred Drug List PDL (September 1, 2022)
- Nebraska Total Care 90-Day Maintenance Drugs (Excel) (September 13, 2022)
- Pharmacy Update: CVS Caremark (PDF) (effective August 1, 2021)
- CVS Caremark MAC Appeals Pharmacy Portal Guide (PDF) (effective August 1, 2021)
- CVS Caremark Pharmacy Portal (effective August 1, 2021)
- Prescription Drug Monitoring Program (PDMP) Presentation (PDF)
- Prescription Drug Monitoring Program (PDMP) Registration FAQ (PDF)
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 Medical Necessity (PDF) (effective April 27, 2022)
- Buprenorphine Consent (PDF) (effective April 27, 2022)
- Buprenorphine/Naloxone Prior Auth (PDF) (effective April 27, 2022)
- Growth Hormone Prior Auth (PDF) (effective April 27, 2022)
- Hepatitis C Prior Auth (PDF) (effective April 27, 2022)
- Hereditary Angioedema (HAE) Prior Auth (PDF) (effective April 27, 2022)
- Quantity Limit or High Dose Override Prior Auth (PDF) (effective April 27, 2022)
- Nebraska Total Care Specialty Pharmacies (PDF) (September 22, 2021)
- Nebraska Total Care Hemophilia Pharmacies (PDF) (September 22, 2021)
- Nebraska Total Care Specialty Medication Drug List (PDF) (August 1, 2021)
Contact Us
CVS Caremark Help Desk
Phone: 888-321-2351
Pharmacy Services
Prior Auth Phone: 844-330-7852
Prior Auth Fax: 833-404-2254
Nebraska Total Care
Phone: 1-844-385-2192 (TTY 711)