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 844-205-3384.
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
- Separate YouthCare prior authorization is not required
YouthCare pharmacy team enter approvals and denials directly into the PBM adjudication platform
For Screen Reader: Provider sends consent to DCFS consultants, DCFS consultants assess content, DCFS consultants sends decision to YouthCare, YouthCare enters overrides in pharmacy system, Member/guardian pick up psychotropic medication from pharmacy
Psychotropic Medication Request Form (CFS 431-A) (PDF) should be faxed to (312) 814-7015
YouthCare’s Pharmacy Services PA department 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
- Pharmacy Services PA deparment: 833-491-0418
- DCFS Consent Unit Hotline: 800-828-2179