Pharmacy

HAP CareSource MI Health Link Pharmacy has partnered with Express Scripts® to help you manage your prescriptions and save money.

Prescription Drug Benefits

With HAP CareSource MI Health Link you receive more of the medications you need with no copays for covered prescriptions and some non-part D and over-the-counter (OTC) drugs as specified by the Michigan Department of Health & Human Services (MDHHS).

Have questions about your medication? Ask a pharmacist!

Talk to a HAP CareSource MI Health Link pharmacist to review your medication and get your questions answered. Depending on your medications and conditions, our pharmacists may even reach out to you to check in on your medications. As a HAP CareSource MI Health Link member, you get this benefit for free. No appointment needed! Call 1-833-230-2073 to speak with a pharmacist today! We are open 9 a.m. to 5:30 p.m., Eastern Time (ET) Monday through Friday.

Comprehensive Drug Formulary

HAP CareSource MI Health Link uses a Formulary. The formulary shows the drugs we want your primary care provider (PCP) to order for you. Some drugs require prior authorization. Some drugs may also have quantity limits, and some drugs may require step therapy.

The comprehensive formulary is a list of Part D drugs covered by your Part D plan and drugs covered by your Medicaid benefit only:

Throughout the year, changes may occur to drugs on our formulary. Check this list to view the updates.

Prior Authorization Criteria – For certain drugs, your doctor will need to contact us before you can fill your prescription.

Visit our Plan Documents page to see the Part B (medical drugs) Prior Authorization List.

Step Therapy Criteria – For certain drugs, we require you to first try another drug to treat your medical condition before we will cover the drug your doctor initially prescribed.

Generic vs. Brand Name Drugs

It is the policy of HAP CareSource MI Health Link to limit the use of a brand name drug when a generic version is available. Generally, a generic drug works the same as a brand name drug and usually costs less. Please see your member handbook on the Plan Documents page for exceptions.

Drug Safety Recalls

Sometimes, the federal government or drug manufacturer issues drug recalls. To find out if a drug you take is being recalled, please check the listings on the Food and Drug Administration (FDA) website.

Quality Assurance

HAP CareSource MI Health Link understands that the accuracy of the formulary is very important. We have utilization management controls in place to promote safe and effective care for members. By reviewing prescription data, we aim to avoid errors and negative drug interactions. Generally, if you are taking a drug on our formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. If these changes occur, no prior notification will be provided before the change is made. We update the formulary monthly or note no change. We do regular audits to ensure the online formulary tool is only the CMS-approved version. We give 30 days’ notice to you when:

  • Taking a drug off the list.
  • Changing a prior authorization.
  • Changing a quantity limit.
  • Changing a cost tier.

You can ask us about drug safety at any time. You can access an online formulary or print one from our website. You may also ask us to mail you a copy. Just call Member Services at 1-833-230-2057 (TTY: 1-833-711-4711 or 711), 8 a.m. to 8 p.m., Monday through Friday.

Non-Opioid Directive Form

With this form, you can tell your health care providers when you do not want to get opioids. This form was created by the state of Michigan. You (or legal guardians) who want to use this directive can download and fill out the form. Give a copy to your health care providers, including dental providers.

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