To see frequently asked questions about your FamilyCare drug coverage, please click the link below:
Q. What do I do if I go to the pharmacy and the pharmacist tells me that my medicine is not covered?
A. If your pharmacist tells you that your medicine is not covered; there may be another drug that is covered in the Prescription Drug List (PDL). If the drug is not on the PDL, have the pharmacist call your doctor to ask for a covered drug. You can ask your pharmacist to call PHPMM's Customer Service department at (517) 364-8540 or (877) 661-8299.
Q. What if my medication is not on the Prescription Drug List and it's after business hours?
A. Call our Customer Service Department at (517) 364-8540 or (800) 661-8299 as listed on the back of your member ID card. You will be given a phone number for the answering service that can call the on-call nurse. The nurse will work with you to solve the problem.
Q. Why do I have a co-payment?
A. All Medicaid Members that are 21 years of age and older are required by the Michigan Department of Community Health to pay a $3.00 co-pay for brand named drugs and $1.00 for generic drugs as of July 1, 2006. The only time a Member would not have to pay a co-pay is if:
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They are under the age of 21
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If they are using Family Planning drugs (Birth Control)
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Over-the-Counter drugs or Pregnancy related drugs (Prenatal Vitamins).
Q. How can I get an Over-the-Counter (OTC) drug for free?
A. Your Doctor must write a prescription for the Over-the-Counter (OTC) drug. Give the prescription to the Pharmacy with your PHPMM card and the Pharmacy will be able to bill the prescription for you without a co-pay. Not all OTC drugs are covered. Members can contact PHPMM Customer Service at (517) 364-8540 or (800) 661-8299 if there is a drug that would like to know if it is covered. Please see the attached list of the top 100 OTC medications that are covered here.
Q. Why do some drugs have to be billed to my green mihealth card?
A. This is a requirement of the Michigan Department of Community Health. The attached lists of medications must be billed using your green mihealth card. An authorization may be required for a medication on either list which means that your Doctor will need to call the number on your green mihealth card to receive a prior authorization for these drugs. Click on the link below to see the list of medications that must be billed to your green mihealth card as of 4/1/10. The October list of medication below are medications that have been billed to the green mihealth card since 10/1/04.
Carve Out Medications Effective 4/1/2010
Carve Out Medications Effective 10/1/2004
Q. What is the difference between brand name and generic drugs?
A. Generic drugs are drugs that have the same ingredients as the brand, but they often cost less. Generic drugs can become available only after the rights on the brand name drug expire. At that time, other companies can make a similar drug. Before a generic drug can be sold, the Federal Drug Administration (FDA) must be sure that the drug has the same ingredients in the same dose as the brand name.
Q. Do I have to pay for “over the counter” medicine?
A. For many conditions, an over-the-counter medicine might be all you need. These drugs are covered under your prescription benefit. You will need a prescription from your doctor to get them at no cost. See the list of over-the-counter medicines here.
What is a Prescription Drug List?
The PDL is a list of generic and brand-name prescription medicines that can be used to treat you outside of a hospital. The Food and Drug Administration (FDA) has approved all drugs on the list. A team of doctors and pharmacists meet to review and update the list.
You can find a list of the top 200 medications on the Prescription Drug List (PDL) by clicking here. Together with your doctor, you may use this list to make your choices and pick the right medicine to meet your needs. Keep in mind that your Certificate of Coverage explains your benefit.
Some medicines may need an authorization. Your doctor may call Customer Service at (517) 364-8540 or (800) 661-8299 and ask to be faxed an authorization form. The doctor will be told of the decision. If a request is denied, other medicines may be suggested.
The Medicines in the PDL are picked due to safety and quality standards first, then by cost. The PDL contains more than 800 drugs. The PDL often requires the use of generic drugs.
Pharmacy Department helps you manage your healthcare benefits and authorizes care. Click here for more information.
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How To Reach Us
The Pharmacy Department provides access to staff for members who seek information about the prescription drug list (PDL) or the over-the-counter guide (OTC). Staff is available during normal business hours at the following times:
Monday through Friday from 8:00 a.m. – 5:00 p.m.
The toll free line is: (877) 205-2300
The local line is: (517) 364-8545
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Effective July 1, 2006, there will be changes to the PHPMM-FC co-pay
Effective: July 1, 2006, there will be changes to the PHPMM FamilyCare co-pay amounts:
Co-pay amounts are:
Prescription Drugs: $1.00 for generic drugs and $3.00 for brand name drugs
If you have any questions please call PHPMM-FC Customer Service at (517) 364-8540 or (877) 661-8299 or visit the website www.phpmm.org.