Prescription medicines

Keystone First covers medically needed Food and Drug Administration (FDA)-approved medicines. These medicines are prescribed by your health care provider to help keep you healthy, or treat you when you are sick.

Keystone First gives your health care provider a tool, called a drug formulary, to help him or her prescribe medicines for you. A drug formulary is a list of brand and generic medicines covered by Keystone First.

Keystone First will let members know if they are impacted by any changes made to the drug formulary. If you have questions about whether or not a medicine is covered, you can call your health care provider or pharmacist, or go to Find a Doctor, Medicine, or Pharmacy.

If a certain medicine is not listed on the drug formulary, your health care provider or pharmacist may ask for it through the Keystone First prior authorization process.

When you are trying to fill a prescription for a medicine that is in the prior authorization process:

• If you have not already been taking the medicine, you will receive a 5-day temporary supply of the medicine, as long as the Pennsylvania Medical Assistance program covers it, and the medicine is safe for you to take.
• If you have already been taking the medicine, you will receive a 15-day temporary supply of the medicine, as long as the Pennsylvania Medical Assistance program covers it, and the medicine is safe for you to take.

If you cannot find what you are looking for on our website, please call Member Services at 1-800-521-6860 or take a look at our member handbook. Our representatives are there to help you 24 hours a day, 7 days a week.