Together with CCHP: Update to Drugs that fall under the Pharmacy or Medical Benefits
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Together with CCHP: Update to Drugs that fall under the Pharmacy or Medical Benefits

Certain medications previously covered under the Together with CCHP medical benefit have been moved to the pharmacy benefit, and some medications have been moved from the pharmacy benefit to the medical benefit. 

What does this mean for you? 

Effective January 1, 2019, your office may need to submit prior authorization requests for medications differently, depending on if the drug falls to the medical benefit or the pharmacy benefit.

The attached grid lists all the drugs that require prior authorization and indicates if that drug is considered a medical or pharmacy benefit.

Items that are now covered under the pharmacy benefit and require prior authorization must be completed by downloading an authorization form from togetherCCHP.org/pharmacy-prior-auth and fax it to CCHP Pharmacy Services at 1-844-201-4675. If you have questions regarding drugs that are covered under the pharmacy benefit please contact Pharmacy Services at 1-844-201-4677. After the authorization is received the provider needs to request the drug from Accredo Specialty Pharmacy.    

Items that are covered under the medical benefit and require prior authorization must be completed through the CareWeb QI Authorization Tool which can be found in the CCHP Provider Portal. 

Please review the attached list to see if the medication requires a prior authorization and if it will be processed through the pharmacy or medical benefit:

Here is the medication list

Helpful tips:

Medications that are moving from medical benefit to the pharmacy benefit Medications moving from pharmacy benefit to medical benefit:

This means your patient must obtain their medication from a specialty pharmacy.

If your patient was affected by this change, their authorization was transferred to the pharmacy benefit.

The authorization expiration date did not change.

This medication must now be medically billed through either the buy and bill process or medically billed through a specialty pharmacy (if they are able to).

If your patient was affected by this change, their authorization was transferred to the medical benefit.

The authorization expiration date did not change.

How do you submit for prior authorization?

Download an authorization form from togetherCCHP.org/pharmacy-prior-auth and fax it to Together with CCHP Pharmacy Services at 1-844-201-4675.

How do you submit for prior authorization?

These medications will need to be submitted through CareWeb Qi Authorization Tool which can be found in the Provider Portal

Learn how to submit an authorization.

Questions:

Please contact Pharmacy Services at 1-844-201-4677. 

Questions:

Please visit Together with CCHP's website or call 1-414-266-5747.


 

Medicaid

Children's Community Health Plan

PO Box 56099
Madison, WI 53705
1-800-482-8010

Together with CCHP

Children's Community Health Plan

PO Box 1997, MS 6280
Milwaukee, WI 53201
1-844-201-4672

 

National Committee for Quality Assurance (NCQA) Accreditation

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