Pharmacy

Oklahoma Complete Health Children’s Specialty Program 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.

What Pharmacy Benefits are covered?

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.

Which Drugs are covered?

The Preferred Drug List (PDL) is a list of drugs covered by Oklahoma Complete Health which follows the guidance of 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 a Drug Utilization Review Board. to promote the appropriate and cost-effective use of medications.  Prior authorization criteria also follows State of Oklahoma guidance.

To view the Children's Specialty Program Preferred Drug List, visit the Manuals and Forms page.

You can request a copy of the PDL by calling Member Services at 1-833-752-1665 (TTY: 711).

Specialty Drugs

A specialty drug is a prescription drug that requires special handling, administration or monitoring. These are usually prescribed by your medical provider through an in-network specialty pharmacy.

How Do I Get Medications?

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 Children’s Specialty Program ID Card. If you need help finding a pharmacy near you, call us at 1-833-752-1665 (TYY: 711).

What if I can’t get the medication my/my child’s doctor approved?

If you have no medication remaining and are waiting on a Prior Authorization please call [Phone Number Coming Soon] for assistance.

Can I Get a Prescription with More Than a 30-day Supply?

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, Maintenance Drug List page. This is an external link that will take you outside the Oklahoma Complete Health website.

Where Can I Get My Prescription Filled?

To find a pharmacy that is in the Oklahoma Complete Health network, you can use the Find a Provider 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.

What if I go to a drug store not in the network?  

It is important to show your ID card at the pharmacy to make sure the prescription is processing properly or you may need to go to another pharmacy to prevent having to pay for the medication. If you need help finding a pharmacy near you, call us at  1-833-752-1665 (TTY: 711).

What if I have other primary insurance?

If you have other health insurance, that insurance could be primarily responsible for your care. Please show both your primary insurance card and your Children’s Specialty Program card at the drug store.

Over the Counter

Up to $50 per household per quarter 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.

Over-the-Counter Product Value Added Benefit Flyer (PDF)

Over-the-Counter-Product Value Added Benefit Catalog (PDF)

What if I need Durable Medical Equipment (DME) or other products from a pharmacy? 

Some Durable Medical Equipment (DME) and products normally found in a pharmacy are covered by SoonerSelect Children's Specialty Program. For example: Supplies for insulin pumps

What if I lose my/my child’s medications?

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.