Using Your Children’s Prescription Benefit
Getting Your Prescriptions Filled
If your children need medicine, their PCP or specialist will write a prescription. Take the prescription slip to any KidzPartners participating pharmacy. Hundreds of area pharmacies will accept a KidzPartners ID card, including major chains and independents.
You can use the online Find a Doctor tool to find a pharmacy near you.
Any applicable copays are due when you pick up your prescriptions.
KidzPartners members can also view pharmacy claims and get other prescription benefit information on our pharmacy portal.
If there is a problem with your KidzPartners prescription coverage, call Member Relations for help.
If your children's medicine is not on our formulary
If your child is currently taking a medication that is not on the formulary and your doctor would like your child to continue to receive this medication, your doctor will need to call Health Partners Plans for a prior authorization.
If your child receives a prescription for a non-formulary medication, the pharmacist may call your child's doctor. The pharmacist may ask about changing the prescription. If the doctor cannot be contacted, you usually will receive a temporary supply of medication.
- You will get a 5-day supply if it is a new prescription for your children and not part of an ongoing treatment.
- You will get a 15-day supply of the medication if your child has already been receiving the medication on an ongoing basis, without a break in treatment of more than 34 days.
- You will get a 15-day supply if it is a medication ordered on an “as needed” (PRN) basis, without a break in treatment of more than six months.
During this time we will review your doctor’s request to cover the drug.
Your child’s doctor can contact Health Partners Plans’ Pharmacy department if he or she believes that it is medically necessary for your child to receive a non-formulary medication. The doctor can then request a medical exception for this drug.
If Health Partners Plans does not approve the doctor’s medical exception request, you may file a grievance with Health Partners Plans. You may also request an expedited (48-hour) grievance.
Please see your KidzPartners Member Handbook for more information.