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) (October 1 2021)
- Nebraska Total Care Value-Add Formulary (PDF) (October 1, 2021)
- Nebraska Total Care Over-the-Counter Approved Products (Excel) (September 16, 2021)
- Nebraska Total Care Machine Readable Formulary (JSON)
- Nebraska Medicaid Preferred Drug List PDL (October 1, 2021)
- Nebraska Total Care 90-Day Maintenance Drugs (Excel) (December 16, 2020)
- Pharmacy Update: Heritage Health Adult Expansion Program (PDF) (October 1, 2020)
- 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)
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 August 1, 2021)
- Buprenorphine Consent (PDF) (effective August 1, 2021)
- Buprenorphine/Naloxone Prior Auth (PDF) (effective August 1, 2021)
- Growth Hormone Prior Auth (PDF) (effective August 1, 2021)
- Hepatitis C Prior Auth (PDF) (effective August 1, 2021)
- Hereditary Angioedema (HAE) Prior Auth (PDF) (effective August 1, 2021)
- Quantity Limit or High Dose Override Prior Auth (PDF) (effective August 1, 2021)
- Synagis Prior Auth (PDF) (effective August 1, 2021)
- 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)
- 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
CVS Caremark Help Desk
Phone: 1-888-321-2351
Envolve™ Pharmacy Solutions
Prior Auth Phone: 1-844-330-7852
Prior Auth Fax: 1-866-399-0929
Nebraska Total Care
Phone: 1-844-385-2192 (TTY 711)