Prescriptions (Drugs)

Most prescriptions that are covered may be filled at any pharmacy or drugstore that accepts SoonerCare.

Frequently Asked Questions

• There is a limit of six covered prescriptions per month (including up to two brand-name drugs). The pharmacy has to give you a generic drug when one is available, unless the OHCA prefers the branded drug. When we prefer the branded drug over the generic drug, that branded drug will not count towards your monthly brand prescription limit. Your doctor may need to have some drugs approved by SoonerCare.
• Prescriptions for birth control, some drugs for HIV/AIDS, some cancer drugs and some smoking cessation products will not count against your prescription limit.
• There is a co-payment of $4 for each prescription.
  

• There are no limits or co-payments for medically necessary prescriptions.
  

You no longer need to show your SoonerCare ID card for medical appointments. You will need to know your medical ID number to fill prescriptions. If you are asked to show an ID card, you can now print it from the member portal if you applied online.

If you are not sure a drug is covered, call the Pharmacy Help Desk at (405) 522-6205 or (800) 522-0114, option 4.

Some services require a Prior Authorization (PA). A PA is not the same as a referral. It means the services must be approved by SoonerCare before you receive them.

• Your doctor must send medical documentation with the PA to show a medical need for the services.
• You and the provider will get a letter from SoonerCare when the services are approved or denied.
• A PA is not a promise of payment.
• Please read your notice.

Step therapy categories have been established to ensure drug products are clinically appropriate and cost effective. Your doctor may submit a request for step therapy exception using form PHARM – 136.

If your exception has been denied, you have the right to file an appeal on the denial to the agency’s administrative law judge using form LD-5.

If you have questions, call the Pharmacy Help Desk at (405) 522-6205 or (800) 522-0114, option 4.

Smoking and tobacco can cause many major health problems. SoonerCare offers free smoking cessation benefits. Ask your health care provider about medications or call the Oklahoma Tobacco Helpline for coaching.

Covered products include nicotine patches, gums and lozenges, as well as other pills that combat cravings.

You can get smoking cessation products as a pharmacy benefit for up to 6 months. Those products will not count toward the monthly limits for members age 21 and older.

For more information:

Oklahoma Tobacco Helpline:
1-800-784-8669 (English)
1-800-793-1552 (Spanish)
1-877-777-6534 (TTY)