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Getting Your Prescriptions Filled
If your children need medicine, their PCP or specialist will write a prescription. Simply take the prescription slip to any KidzPartners participating pharmacy. Hundreds of area pharmacies will accept your children's KidzPartners ID card, including major chains and independents. (Check the KidzPartners Provider Directory, or use the online "Find a Doctor" tool on this website, to find a pharmacy near you.) Copays, if applicable, are due when you pick up your prescriptions.
If there is ever any problem with your KidzPartners prescription coverage, you can call Member Relations from the pharmacy for help.
If your children's medicine is not on our formulary
There may be occasions when a medication your children are currently taking is not listed on the formulary. If your children's doctor would like them to receive this medication in place of one that is on our formulary, the doctor will need to call Health Partners for a prior authorization. Please talk with your children's doctor about using medications that are listed on the formulary.
We stay in touch with all KidzPartners participating physicians and pharmacies. We give them information about our prescription drug benefit and the formulary. If your children receive a prescription for a non-formulary medication, the pharmacist may call your children's doctor. The pharmacist may ask about changing the prescription. If the doctor cannot be contacted, you usually will receive a temporary supply of medication.
You will get a 5-day supply if it is a new prescription for your children (not part of an ongoing treatment. You will get a 15-day supply if the medication is one your children have been receiving on an ongoing basis (without a break in treatment of more than 34 days). You will also get a 15-day supply if it is a medication ordered on an "as needed" (PRN) basis (without a break in treatment of more than six months). During this time Health Partners will review your doctor's request to cover the drug.
Your children's doctor can contact Health Partners' Pharmacy department if he or she believes that it is medically necessary for them to receive a non-formulary medication. The doctor can then request a medical exception for this drug. If Health Partners does not approve the doctor's medical exception request, you may file a grievance with Health Partners. You may also request an expedited (48-hour) grievance. Please see your KidzPartners Member Handbook for more information.
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