Frequently Asked Questions - Pharmacy    

• What information is needed when I call the Pharmacy Help Desk?
  Due to HIPAA guidelines, we need to know the member’s full name, date of birth, last 4 digits of their social security number or their member ID before any information can be released. 
• Do I need my SoonerCare ID card or my ID number to fill 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. You no longer need to show your SoonerCare ID card for medical appointments. 
• How do I get my SoonerCare ID number?
  If you are asked to show an ID card, you can now print it from the member portal if you applied online at www.mysoonercare.org. If you applied through the Department of Human Services, they can print an ID card for you. 
• My Pharmacy said my prescription needs a Prior Authorization. What does this mean? What should I do?
  Some medications require special approval before your pharmacist can fill them. Ask the pharmacy to fill out the pharmacy portion of the prior authorization and forward it to your doctor’s office. Once your doctor fills out the prescriber portion, it will be forwarded to the SoonerCare Pharmacy Help Desk for review.
• How can I find out if a medication will require a Prior Authorization?
  Contact the Pharmacy Help Desk.
• How can I find out the status of a Prior Authorization?
  Contact the Pharmacy Help Desk.
• Will my prior authorization be good at any pharmacy?
  No, all prior authorizations are pharmacy-specific.
• Why was my Prior Authorization denied?
  It could be that something was left off or more information is needed. If this happens to you, follow up with your pharmacy and doctor’s office. The SoonerCare Help Desk will send them information explaining the reason for denial.
• How can I find out how many prescriptions SoonerCare will cover each month?
  For coverage information specific to you contact the Pharmacy Help Desk.
• How can I find out what my prescriptions co-payment will be?
  For those members 21 years of age or older, co-payment will be $4. 
• For those members under 21 years of age or in a long-term care facility:
  There is no co-pay.
• How can I get my diabetic testing supplies covered through SoonerCare?
  You can get your diabetic testing supplies just like you do your prescriptions at your pharmacy. Diabetic supplies have no copay and will not count against your monthly prescription limit.  
• Are smoking cessation products covered through SoonerCare?
  Yes, smoking cessation products are covered and do not count against your prescription limit.
• Is birth control covered through SoonerCare?
  Most birth control is covered and does not count against your prescription limit.
• I received a prescription from an out-of-state doctor; will SoonerCare pay for the prescription?
  SoonerCare will pay for prescriptions written by SoonerCare contracted doctors.  If the out-of-state doctor is a SoonerCare doctor, then it will be covered. If they are not a SoonerCare doctor, the prescription will not be covered by SoonerCare.
• Can I get a prescription filled at an out-of-state pharmacy?
  For SoonerCare to pay the out of state pharmacy, the pharmacy must have a current contract with SoonerCare.
• I lost a recently-filled prescription. What should I do?
  Have your pharmacist call the Pharmacy Help Desk to request an override. Depending on circumstances it may or may not be refilled. This type of override can be done only once a year. If your medication was stolen, you will be asked to provide the police report.
• Will SoonerCare pay for an early refill if I am going on vacation?
  No, SoonerCare will not authorize early refills due to vacations. This is only allowed if you are leaving town for a medical procedure for yourself. 
• How can I get a reimbursement for a prescription I paid for?
  This depends upon the individual pharmacy's policy. Generally, once the prescription is submitted to SoonerCare and paid, the pharmacy may issue a refund.
• I cannot afford my co-payment and the pharmacy has already filled my prescription. How can I get it?
  A pharmacy cannot deny medication based on inability to pay the co-payment, however the pharmacy may bill you for the co-payment.
• I am eligible for benefits under the Family Planning Program (SoonerPlan). What prescriptions are covered under Family Planning?
  Only family planning products or birth control medications. Click here for a list of those covered products.
• What can I do if I need more prescription “punches” per month? 
  Based on your qualifications, it is possible to receive up to 13 prescriptions a month through the ADvantage Waiver program. If you do not qualify for the ADvantage Waiver program, you may apply for help with additional prescriptions through the RX for Oklahoma service by calling 877-794-6552.
• How can I find out if I qualify for ADvantage Waiver prescription assistance?
  Speak with your local DHS Caseworker or call the ADvantage Waiver Program at (800) 435-4711.