If you are a member of Prestige Health Choice, you will receive medication, or medication benefits. We try to make it easy for you to get the medicine that you need.
Getting your medication
Your doctor will write you a prescription. You must pick the medicine up at a pharmacy that is part of the Prestige network. You'll find a list of pharmacies in your Prestige provider directory.
There is no cost to you for prescriptions. Show your Prestige member ID card when you get your prescriptions. If you have any questions, call Pharmacy Member Services toll-free at 1-855-371-3963 if you need help.
Prior authorization (pre-approval)
Your doctor may write a prescription for a medicine that is not on the Prestige drug listing. Your doctor will need to send us a prior authorization request form. We will review and let your doctor know our decision.
If Prestige 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 the 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 concern, 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.
Prestige covers some over-the-counter (OTC) medicine. There is a limit to how much OTC medicine you can get. The coverage of OTC medicine is limited to a maximum of $50 per year, per household.
A parent or guardian must sign informed consent for psychotropic medicines for children under 13 years old. Your PCP will ask you to sign a form. Please ask your PCP for help.
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 my apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change.