IHN-CCO will pay for most drugs if you have a prescription from your primary care provider, primary care dentist or mental health provider. You may fill prescriptions at almost any pharmacy in Benton, Lincoln and Linn counties. Just ask your pharmacy if they accept IHN-CCO.
IHN-CCO uses a “formulary” for prescription drugs. A formulary is a list of covered prescription drugs. All IHN-CCO providers have a copy of the formulary in their office. When you need a prescription, your doctor will choose a drug from the formulary. Drugs that are not on the formulary are called non-formulary. If you would like a copy of our formulary, call our Customer Service Department and we will send you one within five business days.
IHN-CCO covers many over the counter (OTC) drugs which will be listed on our formulary. If an OTC drug on formulary is listed with a limit on the number you can get, or prior approval is needed, you may need to get approval. If an OTC drug is not listed on the formulary, a prior approval will be needed before IHN-CCO will pay for the drug.
As an IHN-CCO member you can get birth control from any provider. You do not need a referral or prior approval.
If there are problems with the pharmacy filling your prescription, your provider can call our Customer Service Department at 541-768-7863, or 866-203-3435 (TTY 800-735-2900 or 711).
If for some reason you need a drug that is not on the IHN-CCO formulary, your doctor can ask for an exception. Our Pharmacy Director will decide if it is medically needed for you to have a drug that is non- formulary. If you have a high medical need for the prescription, we will pay for the non-formulary drug.
Be sure to talk to your PCP, PCD or mental health provider who can provide the drug before you go out of town. They can help you get medication refills before you leave or tell you what to do if you run out of medication.
Search our formulary by medication name or type. Search results include:
Dual-eligible refers to members who qualify for both Medicare and Medicaid benefits. If you have dual eligibility, IHN-CCO (Medicaid) will cover formulary over-the-counter medicine (drugs) and all other medicine prescribed by your provider will be billed to your Medicare plan.
You may also download and print formularies:2024 IHN-CCO Formulary (English) 2024 IHN-CCO Formulary – Dual Eligible (English)
IHN-CCO Formulary in a Machine Readable Format (English)
We require you to get prior authorization for certain drugs. This means that you, your authorized representative, or your provider will need to get approval from us before you fill your prescription. Without approval, we may not cover the drug.
IHN-CCO Prior Authorization Criteria (English)IHN-CCO Prior Authorization Criteria – Dual Eligible (English)
In some cases, we require you to first try one drug to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may require your doctor to prescribe Drug A first. If Drug A does not work for you, then we will cover Drug B.
2023 IHN-CCO Step Therapy Criteria (English)
The information on this page is a summary of your IHN-CCO benefits. For a full description of the benefits and services available to you, read your Member Handbook (English) and Member Handbook (Español).
IHN-CCO has a national network of contracted pharmacies. Most major chain pharmacies and many independently-owned pharmacies are contracted with IHN-CCO and can fill prescriptions for our members.
Here are a few forms you or your provider may need. These forms relate to your prescription coverage:
