Pharmacy Services
Access to Safe and Effective Medications:
At YouthCare, our goal is to provide the right drug coverage for our members. We work closely with doctors and pharmacists to make sure we offer medications that treat a range of conditions and illnesses. We are proud to work with partners who help us provide innovative and personalized pharmacy solutions. These partnerships help improve member health and make treatments more affordable. They ensure you have access to important medications. You also get support through personalized clinical programs.
Medication Coverage
How to get no-cost medications
We help you get the medications you need. In fact, there are no copays for covered or approved drugs filled at an in-network pharmacy.
The Preferred Drug List (PDL)
is the list of drugs covered by YouthCare. This list includes prescriptions and over-the-counter drugs used for treatment. The YouthCare PDL is based on the State of Illinois Department of Health and Family Services’ PDL. YouthCare asks that doctors prescribe medications from the YouthCare preferred drug list for their patients who are members of YouthCare. Most are covered without a referral or medical review.
If your medication is not on the preferred drug list or is on the preferred drug list but has limitations, you can:
- Speak with your doctor about switching to a similar medication that is on the preferred drug list.
- Request a prior authorization, or speak to your doctor about submitting a prior authorization for you. Your doctor may do this by submitting the Medication Prior Authorization Form (PDF), or by calling (800) 460-8988.
Once we approve the exception, you can get the prescription filled. Note: we cannot make any exceptions for drugs excluded by the State of Illinois.
We have a large network that lets members access many types of pharmacies. This includes retail, mail-order, and specialty pharmacies. This makes it easy for you to get your medications. We work closely with our pharmacy partners to make sure they meet your needs as a YouthCare member.
If you have questions or problems with your prescription, call YouthCare member services. Dial the toll-free number 844-289-2264 found on your Medicaid ID card.
Fill and Receive Your Prescriptions
You can have your prescriptions filled at a network pharmacy. At the pharmacy, you will need to give the pharmacist your prescription and your YouthCare ID Card.
Billing information:
RX BIN: 003858
RX PCN: MA
RX GROUP: 2EJA
To find a nearby in-network pharmacy, use our Provider Finder tool. You’ll be prompted to enter your location and select your network. Then choose the “Pharmacy & Medical Supplies” category.
You can also call us for help locating a pharmacy or if you’re having trouble getting your medication, call 844-289-2264 (TTY: 711), Monday through Friday, 8 a.m. to 6 p.m.
If you paid cash for a medication, fill out the YouthCare Prescription Claim Reimbursement Form (PDF) with a note explaining why you paid cash. Be sure to include the drug name and attach the receipt from the pharmacy.
YouthCare offers a mail-order pharmacy service. It allows members to receive a 90-day supply of certain maintenance medications delivered to their door. This saves members time and money. The service increases medication adherence while offering significant cost savings. These drugs are used to treat long-term conditions or illnesses. A list of maintenance medications can be found by accessing the PDL.
Call Express Scripts® Pharmacy at 833-750-4300 to do any of the following:
- Transfer a current prescription
- Request a prescription refill
- Have your doctor phone a prescription directly to our mail order pharmacy
Pharmacy Services
We work with our pharmacy partners to create solutions that fit the needs of each provider and member. This approach enhances care coordination, improves clinical outcomes, and lowers risks. This leads to better patient satisfaction and care delivery.
The Illinois Department of Children and Family Services (DCFS) provides consent for psychiatric care for youth in the state’s custody. Written consent from the DCFS Guardian must be obtained prior to prescribing a psychotropic medication to a youth. The list of psychotropic medications that require DCFS consent will be defined and updated by the DCFS Centralized Psychotropic Medication Consent Program.
Consent forms should be sent to the DCFS Centralized Psychotropic Medication Consent Program. The Program will send YouthCare their decisions. After YouthCare enters the decision into the system, the pharmacy can process the prescription.
If you have questions about a consent, call us at 844-289-2264 (TTY: 711). Hours are 8 a.m. to 6 p.m., Monday through Friday.
Clinical Programs
A targeted, system-generated review program that aims to identify clinically relevant drug therapy problems (DTPs) using pharmacy claims and medical diagnoses based on established logic. The system is capable of:
- Reviewing medication profiles to identify drug-related problems such as:
- Drug-drug interactions
- Duplicate therapy
- Excessive use or duration of therapy
- Inappropriate or suboptimal use
- Lack of therapy
- Sending faxes to providers with recommendations on resolving DTPs
- Generating letters to members with information on DTPs
- Tracking problems to resolution.
Pharmacists attempt to close unresolved DTPs every 90 days until the end of the year.
More Information
YouthCare covers certain prescription drugs and over-the-counter drugs when prescribed by a YouthCare provider. The pharmacy program does not cover all drugs. Some require prior authorization. Some drugs have limitations on age, dose, or quantity.
The Preferred Drug List (PDL) is the list of drugs covered by YouthCare. The YouthCare PDL is based on the State of Illinois Department of Health and Family Services’ PDL. YouthCare works with providers and pharmacists to ensure that prescription medications used to treat a variety of conditions and diseases are covered under the pharmacy benefit. The PDL applies to drugs you receive at retail pharmacies.
View the Preferred Drug List (PDF).
If your medication is not on the preferred drug list or is on the preferred drug list but has limitations, you can:
- Speak with your doctor about switching to a similar medication that is on the preferred drug list.
- Request a prior authorization, or speak to your doctor about submitting a prior authorization for you. Your doctor may do this by submitting the Medication Prior Authorization Form (PDF), or by calling (800) 460-8988.
You can have your prescriptions filled at a network pharmacy. At the pharmacy, you will need to give the pharmacist your prescription and your ID card. If you need help finding a pharmacy near you, call us at 844-289-2264 (TTY: 711). Hours are from 8:00 a.m.- 6:00 p.m. (CST) Monday through Friday. Having trouble getting your medication? Call YouthCare at 844-289-2264 (TTY: 711).
YouthCare also offers a 90 day supply (three month supply) of maintenance medications at any network pharmacy. These drugs are used to treat long-term conditions or illnesses. A list of maintenance medications can be found by accessing the PDL (PDF). To transfer a current prescription, request a prescription refill, or have your doctor phone a prescription directly to our mail order pharmacy, call Express Scripts® Pharmacy at
Billing information:
RX BIN: 003858
RX PCN: MA
RX GROUP: 2EJA
If you paid cash for a medication, fill out the YouthCare Prescription Claim Reimbursement Form (PDF) with a note explaining why you paid cash. Be sure to include the drug name and attach the receipt from the pharmacy.
To find a pharmacy that is in the YouthCare network, you can use the Find a Provider tool. Type in your city or zip code, and then click Submit. Scroll down and click on Pharmacy & Medical Supplies. Click on Pharmacy and enter the kind of pharmacy (optional). Click Search. Only those pharmacies in the YouthCare network are listed.
Some medications may require a prior authorization (PA). A PA is a decision by your health insurer or health plan that a prescription drug is medically necessary. It can also be called prior approval or precertification.
Your provider will submit any needed PAs. You do not need to contact us to request a PA.
You will receive a letter after your health plan makes a decision on a PA. If approved, the letter will have the dates of approval. If denied, the letter will give the reason the PA was not approved. If you have questions about a PA, call us at 844-289-2264 (TTY: 711). Hours are from 8 a.m. - 6 p.m. CST, Monday through Friday.
The Illinois Department of Children and Family Services (DCFS) is responsible for providing consent for psychiatric care for youth in the state’s custody. Written consent from the DCFS Guardian must be obtained prior to prescribing a psychotropic medication to a youth. The list of psychotropic medications that require DCFS consent will be defined and updated by the DCFS Centralized Psychotropic Medication Consent Program.
Consent forms should be sent to the DCFS Centralized Psychotropic Medication Consent Program. The Program will send Youthcare their decisions. After YouthCare enters the decision into the system, the pharmacy can the process the prescription.
If you have questions about a consent, call us at 844-289-2264 (TTY: 711). Hours are from 8 a.m. - 6 p.m. CST, Monday through Friday.
Learn More
Get in Touch: For more information, call our Pharmacy Services team at 855-580-1688.