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You can call Member Services at 1-888-348-2922 (TTY: 711). We’re here for you 24 hours a day, 7 days a week­­­.

Medicaid pharmacy benefits

Medicaid pharmacy benefits

There are 2 groups of medications, and each is handled in a different way. 

 

  1. Inpatient medications: the medications you get from a provider while you’re in a doctor’s office, a hospital or an infusion center
  2. Outpatient medications: the medications your doctor prescribes that you pick up later at the pharmacy

Read on to learn how these are handled and how to find a pharmacy near you.

 

How your pharmacy coverage works

 

We handle any medications you take while at your doctor’s office, in the hospital or at an infusion center (inpatient medications). The medications you pick up at the pharmacy (outpatient medications) are handled by Gainwell Technologies. Gainwell is your pharmacy benefits manager (PBM), and you can see the medications they cover on the preferred drug list (PDL).

 

Questions about medication coverage? 

 

You can call Gainwell Technologies at 1-888-483-0797.

 

CHIP pharmacy benefits

 

We manage medications given in your doctor’s office, while you are in the hospital or in an infusion center (inpatient medications). All outpatient medications are covered under West Virginia’s CHIP Fee-For-Service plan. If you have questions about your outpatient medications, you can visit the WVCHIP website. Or call 1-800-241-3260. 

 

At least once a year, WV CHIP decides if they will cover any new medications. You can see the most current drug list (PDF) anytime on their website.

 

Find a pharmacy

 

Medications you pick up at the pharmacy are handled by the West Virginia Medicaid Management Information Systems (WVMMIS) network. 

 

To find a CHIP or Medicaid pharmacy in the network near you:

 

  1. Visit WVMMIS Provider Search.
  2. Go to “Type” and choose “Pharmacy”.
  3. Enter your location info.

Pharmacy coverage decisions

Pharmacy coverage decisions

Aetna Better Health does not:

 

  • Decide what brand of medications you are given
  • Replace one medication for another
  • Place limits or quotas on medications

 

To learn more about your medication coverage, just call us at 1-888-348-2922 (TTY: 711)

 

Prior authorization (PA)

 

Some medications may need PA, or approval, before you receive them. This means your providers need permission to provide certain medications. They’ll know how to do this. And we’ll work together to make sure the medication is what you need.

 

Learn more about PA