Skip to Main Content

Pharmacy

YouthCare is committed to providing appropriate, high-quality, and cost-effective drug therapy to all members. YouthCare covers prescription medications and certain over-the-counter medications with a written order from a YouthCare 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 are covered as well.

Prior Authorization

Prior Authorizations may be submitted electronically via CoverMyMeds or by faxing the Medication Prior Authorization Form (PDF) to 866-399-0929. 

Psychotropic Medication Consent Process

DCFS Rule and Procedure 325 require psychotropic medications consent for DCFS children

An efficient system for psychotropic medication consent process has been created

  • Pay claims at the point of sale only when consent is on file with YouthCare HealthChoice and DCFS
  •  Provide customized reject messaging to pharmacists informing them of consent and/or prior authorization requirements
  • All non-psychotropic medications are reviewed via the standard review process
  • Prior authorizations received for psychotropic medications are returned to provider with consent information
YouthCare receives files throughout the day from DCFS consultants containing approved and denied consents
  • Separate YouthCare prior authorization is not required

YouthCare and Envolve Pharmacy Solutions teams enter approvals and denials directly into the PBM adjudication platform

Psychotropic Medication Request Form (CFS 431-A) should be faxed to (312) 814-7015

YouthCare’s pharmacy help desk at Envolve Pharmacy Solutions (EPS) is equipped to provide 24/7 pharmacy support. The call center is able to:

  • Provide help with claims processing issues
  • Triage calls to YouthCare as appropriate

 Contacts

  • Envolve Pharmacy Solutions: 833-491-0418
  • DCFS Consent Unit Hotline: 800-828-2179