It is important to YouthCare that our members receive drug therapy that is appropriate, high quality and cost effective. We work hard to ensure you can get safe and effective medications that are medically proven to help you get healthy and stay healthy.
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 Caremark at (888) 624-1139 or go to the Caremark website.
RX BIN: 004336
RX PCN: MCAIDADV
RX GROUP: RX5490
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. e. 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.