Paramount Advantage will pay for all medically necessary Medicaid-covered prescription drugs and medical supplies your medical provider prescribes. Prescriptions can be filled at any participating pharmacy. A list of Paramount Advantage pharmacies is available for your convenience.
While Paramount Advantage covers all medically necessary Medicaid-covered prescription drugs, we use a preferred drug list (PDL). These are the drugs that we prefer that your provider prescribes. We may also require your provider submit information to us to explain why a specific medication and/or certain amount of medication is needed. We must approve the request before you can get the medication, this process is called prior authorization. Please refer to the PDL for drugs that require prior authorization. Some drugs may also have quantity (amount) limits and some drugs are never covered, such as drugs for weight loss. Reasons why we may prior authorize a drug include:
- There is a generic or pharmacy alternative drug available
- The drug can be misused/abused
- There are other drugs that must be tried first
Specialty Drug Program Information
Our Specialty Drug Program provides the medication used to treat complex acute and chronic conditions such as multiple sclerosis, cancer, and rheumatoid arthritis. Although these drugs are self-administered, their complexity and strength often require special handling and monitoring.
The Paramount Advantage Preferred Drug List includes a comprehensive list of preferred specialty drugs. Most specialty drugs require a prior authorization and we may require your provider to submit information to us to explain why a specific medication is needed. Drugs available under the Specialty Drug Program must be obtained from a pharmacy in our Specialty Pharmacy Network.