Prescription Drug Information
KidzPartners offers prescription drug benefits to all members.
Getting Prescriptions Filled
If your child needs medicine, their PCP or specialist will write a prescription and send it to the pharmacy of your choice. There may be a copay for the prescription.
Hundreds of local pharmacies, including large chains (like CVS and Rite Aid) and independent pharmacies, are in the KidzPartners pharmacy network. You can use the online provider directory to find a pharmacy near you.
As a member of KidzPartners, you can access other prescription benefit information and view pharmacy claims by using our pharmacy portal.
If you experience any problems with prescription coverage, call Member Relations at 1-888-888-1211 (1-877-454-8477) at any time for help.
A formulary is a list of preferred medications chosen by KidzPartners. Your children’s doctor uses our formulary when choosing which medications to prescribe.
The formulary contains two kinds of drugs: brand name drugs and generic drugs.
Generic drugs contain the same active ingredients as brand name drugs. The formulary usually does not include a brand name when the same medicine is available as a generic. This may affect which medications your child gets when using their KidzPartners prescription benefit. The formulary also includes certain over-the-counter (non-prescription) drugs that doctors frequently recommend for children. Read our FAQ to learn more about generic drugs.
Health Partners Plans (HPP) works with local doctors and pharmacists to select the drugs in this formulary. The drugs were chosen because they are safe, effective, and of high quality. New drugs and treatments are reviewed regularly. HPP makes changes to the KidzPartners formulary as needed.
If you are thinking about applying for CHIP coverage through KidzPartners, this formulary can also give you helpful information.
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 KidzPartners 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 HPP’s 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 HPP does not approve the doctor’s medical exception request, you may file a grievance with HPP. You may also request an expedited (48-hour) grievance. Please see the KidzPartners Member Handbook for more information.
If you have any questions about your child's prescription drug benefits, call Member Relations at 1-888-888-1211 (TTY 1-877-454-8477) at any time.