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Medication Benefits

If you are a member of Prestige Health Choice, you have access to medication benefits. We try to make it easy for you to get the medicine that you need.

Getting your medicines

Your provider will write you a prescription. You must pick the medicine up at a pharmacy that is part of the Prestige Health Choice network. You'll find a list of pharmacies in your Prestige Health Choice provider directory.

There is no cost to you for prescriptions. Show your Prestige Health Choice member ID card when you get your prescriptions. If you have any questions, call Pharmacy Member Services toll free at 1-855-371-3963.

Prior authorization (pre-approval)

Your provider may write a prescription for a medicine that is not on the Prestige Health Choice drug list. If your provider does this, your provider will need to send us a prior authorization request form. We will review and let your provider know our decision.

If Prestige Health Choice does not approve the medicine, you will get a letter that will tell you why. The letter will tell you how to make an appeal if you want to do so.

Pharmacy Member Services

If you have questions, please call Pharmacy Member Services toll-free at 1-855-371-3963.

Finding a pharmacy

You can use any of our participating pharmacies. If you need a list of pharmacies, call Member Services toll-free at 1-855-355-9800 or use our online pharmacy directory.

At the pharmacy

If the pharmacy that you go to has any questions or concerns, they may call our pharmacy benefit manager, PerformRx℠. The PerformRx customer service number is listed on the back of your ID card. A customer service representative will help the pharmacy with your medication.

Other information

Your Prestige Health Choice benefits include an over-the-counter (OTC) medication benefit. If you would like more information, please call Member Services at 1-855-355-9800.

Informed consent

A parent or guardian must sign informed consent for psychotropic medicines for children under 13 years old. Your child’s health care provider should ask you to sign a form if he or she intends to prescribe psychotropic medicines for your child. Please discuss this with your child’s health care provider if you have any questions. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact Member Services at 1-855-355-9800.

Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premiums and/or co-payments/co-insurance may change.