Caring Starts with Pharmacy Coverage Near You

Frequently Asked Questions

• What drugs are covered by my program?

  The Formulary is a list of drugs that are covered by your program. Some drugs require close monitoring and/or may have quantity limits. These drugs are listed on your plan’s Prior Authorization (PA) and Step Therapy (ST) documents. You may estimate the out-of-pocket cost of your prescriptions by clicking here.

  • 2024 Printed Formulary
  • 2024 Searchable Online Formulary
  • 2024 Prior Authorization (PA)
  • 2024 Step Therapy (ST)
• What if my drug is not on the formulary or is not covered in the way I’d like it to be covered?

  There may be a drug you are currently taking or one that you and your provider think you should be taking that is not on our formulary. Your drug could also be on our formulary but covered with restrictions such as requiring prior authorization or step therapy or have a quantity limit. If your drug is not on our formulary or is restricted, here are things you can do:

  • You can change to another drug
  • You can request a Coverage Determination to show you meet prior authorization or step therapy requirements for the drug
  • You can request a Coverage Determination to ask us to cover the drug not on our formulary or to remove the restrictions from the drug. This is called an Exception.
  • In some cases, you may be eligible to get a temporary supply of a drug not on our formulary or a drug that has coverage limits. This is called a Transition supply. Please see the Transition Policy for details. If you qualify to receive a Transition supply, you will also get a letter in the mail that explains what to do next.
• How do I complete a Coverage Determination?

  You may request a Coverage Determination by phone, fax, or mail. You or your doctor may also use the Prompt PA online system to request a Coverage Determination. Contact info is below:

  Phone:  1-800-963-0035

  Fax: 866-806-4134

  Address:
  My Choice Wisconsin
  Pharmacy Services Department
  1617 Sherman Avenue
  Madison, WI 53704

  You have the right to name another person to act for you as your “representative” in asking for a coverage decision. If you want to appoint a trusted friend, relative, or provider as your representative, you may fill out and mail the Appointment of Representative (AOR) form or call our Customer Service team (1-800-963-0035) for assistance.
• What if my request for an authorization or exception is denied?

  If you received a call or letter denying your request, you can ask for the decision to be reviewed again by filing an appeal called a Redetermination.

  You may request a Redetermination by phone, fax, or mail. You or your doctor may also use the Prompt PA online system to request a Redetermination. Contact info is below:

  Phone:  1-800-963-0035

  Fax:  866-806-4134

  Write:
  My Choice Wisconsin
  Pharmacy Services Department
  1617 Sherman Avenue
  Madison, WI 53704

  • Redetermination (Appeal)
  • Prompt PA
  • Evidence of Coverage
• Where can I find a pharmacy near me?

  Please use our online Pharmacy Locator tool to find a location that’s most convenient for you or look up a location in your county using the Pharmacy Directory.

  Members also have access to the Elixir mail order pharmacy (1-866-909-5170). Please see the Mail Order Pharmacy section of the Pharmacy Directory.
• What is the Medication Therapy Management Program?

  Members that have complicated drug regimens may be eligible for our Medication Therapy Management (MTM) Program. This is a free program to help you get the most out of your medications. If you are eligible, our Pharmacy Benefits Manager will send you a letter or call you. Learn more here.

  You may also access a blank copy of a Personal Medication List to help you keep track of the drugs you take. For more information on our MTM program, please call Elixir MTM Customer Service at 866-342-2183. TTY users may call 711.
• I can’t find what I need on this page.

  Our Partnership program has a Member Resources page where you can find information on your pharmacy benefits and coverage:

  • Partnership – Medicare & Medicaid
  • Partnership – Medicaid Only 

  If you have questions directly for the Centers for Medicare & Medicaid Services related to your Part D plan, you can find the CMS website listed on our State & Federal Contacts page.