The Charter Oak Health Plan includes medicines, also called a Pharmacy Benefit. The Pharmacy Benefit covers most drugs that need a prescription. The Pharmacy Benefit also covers some medicines that you can buy “off the shelf” when your provider writes a prescription for it.

If you have questions about your Charter Oak Pharmacy Benefit, you can get answers.

• Talk to your pharmacist.
• Call the Charter Oak Health Plan Pharmacy Customer Call Center toll free at 1-866-409-8430 or local at 1-860-269-2031. Lines are open Monday through Friday from 8:00 a.m. to 5:00 p.m. (except holidays).
• Go to www.ctdssmap.com. Click on Pharmacy Information.

Please call the Charter Oak Health Plan Pharmacy Customer Center to:

• Find a drugstore near you that participates in Charter Oak.
• See if a certain drug or medical item is covered.
• Work with your drugstore to help you get your medicine.
• Tell them your questions or concerns.

Charter Oak providers must prescribe generic drugs. If the provider believes you need a drug that is not a generic, they can ask for special permission to prescribe it. Additionally, your provider can only prescribe certain brand name drugs, also called preferred drugs, unless they get special permission to prescribe a non-preferred drug.

You cannot get a refill on your medicine until you have used 75% of your prescription. Sometimes, depending on your health, the provider can ask for special permission for you to get your refill sooner.

Your prescription benefits are filled by in-state pharmacies that are enrolled in the CT Medical Assistance Programs. To obtain additional medication when traveling out of state, the pharmacy should request approval to fill the prescription before you leave the state.

• Early refills due to traveling are available once every six months.
• Be sure to let your provider know in advance when you will be traveling.

The Pharmacy Benefit does not cover the following types of drugs.

• Drugs used to quit smoking.
• Drugs to treat sexual problems.
• Drugs to treat cosmetic conditions.
• Drugs to treat obesity.
• Experimental drugs.
• Fertility drugs.
• Free shots from the Department of Health.
• Drugs that are ineffective.

Charter Oak members must pay for part of the cost of their medicines. The chart below shows how much you have to pay.

You must pay a co-pay for each prescription that you get. If you get two different prescriptions, you pay two co-payments. You must pay a co-pay for all refills.

You must always show your Charter Oak Health Plan card at the pharmacy in order to get your prescriptions.