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.
Current Drug List
- Preferred Drug List (PDF)
- Over the Counter Drug List (PDF)
- YouthCare Prior Authorization Request Form (PDF)
To prescribe a drug that requires prior authorization and/or a drug is not on the preferred drug list, providers can submit a request using covermymeds or complete a Medication Prior Authorization Request Form (PDF). These forms can be faxed to 844-205-3384. In emergency situations, please phone 844-205-3384.
- Pharmacy Notice 7/30/24 (PDF)
- Pharmacy Notice 6/9/24 (PDF)
- Pharmacy Notice 5/23/24 (PDF)
- Pharmacy Notice 5/3/24 (PDF)
- Pharmacy Notice 4/16/24 (PDF)
- Pharmacy Notice 5/11/23 (PDF)
- Pharmacy Notice 4/26/23 (PDF)
- Pharmacy Notice 3/30/23 (PDF)
- Pharmacy Notice 3/29/23 (PDF)
- Pharmacy Notice 1/18/23 (PDF)
- Pharmacy Notice 1/1/23 (PDF)
- Pharmacy Notice 11/1/22 (PDF)
- Pharmacy Notice 9/29/22 (PDF)
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
Please submit electronic Form CFS 431-A using DCFS Guardian Consent Portal: guardianconsent.dcfs.illinois.gov or 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 department: 833-491-0418
- DCFS Consent Unit Hotline: 800-828-2179
Provider Disputes
- Disputes for pharmacy claims should be submitted via the Express Scripts® Pharmacist Resource Center
- MAC Appeals Instructions