Pharmacy
Oklahoma Complete Health covers most prescription medications. Some prescriptions require prior authorization and may have limitations based on age or the amount of medicine prescribed. Oklahoma Complete Health also covers certain over-the-counter medications with a prescription from an Oklahoma Complete Health provider.
Oklahoma Complete Health covers certain prescription drugs and over-the-counter drugs when prescribed by an Oklahoma Complete Health provider. The pharmacy program does not cover all drugs. Some drugs require prior authorization and may have limitations on age, dosage or maximum quantities.
The Preferred Drug List (PDL) is a list of drugs covered by Oklahoma Complete Health. Oklahoma Complete Health works with the State of Oklahoma to ensure that medications used to treat a variety of conditions and diseases are covered. The PDL applies to drugs you receive at pharmacies. Oklahoma Complete Health's PDL is continually evaluated by Drug Utilization Review Board to promote the appropriate and cost-effective use of medications. Prior authorization criteria also follow State of Oklahoma guidance.
To view the Preferred Drug List, visit the Handbook and Forms page.
You can request a copy of the PDL by calling Member Services at 1-833-752-1664 (TTY: 711).
A specialty drug is a prescription drug that requires special handling, administration or monitoring. These are usually ordered through a specialty pharmacy.
You can have your prescriptions filled at an Oklahoma Complete Health network pharmacy. At the pharmacy, you will need to give the pharmacist your prescription from an Oklahoma Complete Health prescriber and your Oklahoma Complete Health ID Card. If you need help finding a pharmacy near you, call us at 1-833-752-1664 (TYY: 711).
Members may receive up to a 90-Day supply of certain maintenance medications pursuant to the State of Oklahoma’s maintenance drug program. The list of maintenance medications you can receive a 90-day supply of is available at the Oklahoma Health Care Authority website. This is an external link that will take you outside the Oklahoma Complete Health website.
To find a pharmacy that is in the Oklahoma Complete Health network, you can use the Find a Doctor tool. Type in your city or zip code. Then click Update. Choose Other and type the name of your pharmacy. You can also select the pharmacy type in the Select Specialty area. Only those pharmacies in the Oklahoma Complete Health network are listed.
Oklahoma Complete Health has many contracted drug stores that can fill your medications. It is important that you show your ID card at the drug store. If the drug store tells you they do not take Oklahoma Complete Health members, you can call Member Services at 1-833-752-1664 (TYY: 711). We can help you find a drug store that can fill your medications for you. If you choose to have the drug store fill your medications and they do not take Oklahoma Complete Health members, you will have to pay for the medication.
If you lose your medication, you should contact your local drug store to see if a refill is available. You can also call your doctor or clinic if there is no refill available.
If you have other primary insurance, that insurance could be primarily responsible for your care. Please show both your primary insurance and your Oklahoma Complete Health card at the drug store.
Members can submit the Medicaid Prescription Claim Reimbursement Form (PDF) for reimbursement. Pharmacies may also be able reimburse members if they are able to process a claim through the member’s insurance.
OVER THE COUNTER
Over the Counter (OTC) Up to $50 per quarter per household for cold, cough, allergy, vitamins, supplements, ophthalmic/otic preparations, pain relievers, gastrointestinal products, first aid care, hygiene products, insect repellant, oral hygiene products and skin care. This benefit covers items that do not need a prescription. Members will select from a catalog of items supplied by the plan.
Pharmacy Lock-in Program
To protect the health of our members, Oklahoma Complete Health has a pharmacy lock-in program. This is for members who abuse or misuse prescription drugs. Members are assigned to one pharmacy and one doctor. You may change your doctor or pharmacy one time a year unless you have a special situation like moving. If you are placed in the program, you may be enrolled for a minimum of two years. We will review your enrollment at least every year. You also have the option to appeal being placed in the lock-in program.