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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 ESI Pharmacist Resource Center (effective January 1, 2024).

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.

Nebraska Total Care Claim Processing Update

Effective January 1, 2024, Nebraska Total Care will transition to Express Scripts as their pharmacy benefits manager. Please ask members to provide their new member ID cards and enter the new Member ID Number, Rx Group, BIN, and PCN.

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 our Pharmacist Resource Center at prc.express-scripts.com. If you still need assistance processing a claim, please call the Pharmacy Help Desk at 1-833-750-4471.

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.

Contact Us

ESI Express Scripts Helpline
Phone: 833-750-4471
(effective January 1, 2024)

Pharmacy Services
Prior Auth Phone: 844-330-7852
Prior Auth Fax: 833-404-2254

Nebraska Total Care
Phone: 1-844-385-2192 (TTY 711)