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 Caremark Pharmacy Portal.
- Nebraska Medicaid Claim Limitations (PDF) (December 1, 2023)
- Nebraska Medicaid Preferred Drug List PDL (PDF) (December 1, 2023)
- Nebraska Total Care Value-Add Formulary (PDF) (December 1, 2023)
- Nebraska Total Care Over-the-Counter Approved Products (Excel) (September 6, 2023)
- Nebraska Total Care Machine Readable Formulary (JSON)
- Nebraska Total Care 90-Day Maintenance Drugs (PDF) (September 5, 2023)
- Nebraska Total Care Hemophilia Pharmacies (PDF) (December 1, 2022)
- 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.
We are pleased to announce that, effective January 1, 2024, Express Scripts® will begin processing pharmacy claims for our plan members.
Express Scripts is a pharmacy benefit management (PBM) company serving more than 100 million Americans. Express Scripts Pharmacy delivers specialized care that puts patients first through a smarter approach to pharmacy services.
Members will receive a new ID card with updated pharmacy information, so that they are prepared to begin having their prescriptions filled at participating network pharmacies when this change occurs.
Providers can direct members to call the Member Services phone number listed on their ID card should they have questions about this change.
Please contact your Provider Relations Representative with any additional questions.
Express Scripts Transition: Frequently Asked Questions
This FAQ provides additional information on the migration of our Pharmacy Benefit Manager
(PBM) services from CVS® to Express Scripts®, effective January 1, 2024.
Who is Express Scripts?
Express Scripts is a pharmacy benefit management (PBM) company serving more than 100 million Americans. Express Scripts Pharmacy delivers specialized care that puts patients first through a smarter approach to pharmacy services.
What is the rationale for changing PBM vendors?
Express Scripts as our PBM will bring increased levels of transparency and value, positioning us to provide the highest level of quality at the lowest possible cost to our members.
What PBM services will Express Scripts be providing?
Express Scripts will be the PBM of record providing pharmacy claims adjudication, pharmacy network administration and rebate administration on behalf of our health plan.
How will this PBM transition impact our members?
There will be no immediate change in service for our members. We will continue to provide the same member-focused care and support as we do today.
Our highest priority continues to be serving all our members, and we remain committed to providing affordable quality healthcare services. Our team is working closely with both CVS and Express Scripts to ensure a seamless migration.
Is Amazon part of the Express Scripts Network?
Yes, Amazon is part of the Express Scripts network.
- 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)
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)