Pharmacy
Access to Safe and Effective Medications
At Oklahoma Complete Health, our goal is to provide the right drug coverage for our members. Oklahoma Complete Health is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Oklahoma Complete Health members. Oklahoma Complete Health covers prescription medications and certain over-the-counter medications with a written order from an Oklahoma Complete Health provider. The pharmacy program does not cover all medications. Some medications may require prior authorization, and some may have limitations. Other medically necessary pharmacy services are covered as well. Oklahoma Complete Health follows the State of Oklahoma’s preferred drug and prior authorization criteria.
Clinical Programs and Medication Adherence
Oklahoma Complete Health offers special programs that help you stick to your medications and avoid mistakes. These programs are designed to improve your health. We support you in managing long-term conditions and in making sure you get the right medications at the right time to stay healthy.
Maintenance Medication List
Members may receive up to a 90-day supply of certain maintenance medications pursuant to the State of Oklahoma’s maintenance drug program.
Prescription Benefit Enhancement
Oklahoma Complete Health is expanding the prescription benefit to improve access to care. Beginning April 1, 2025, medications across five (5) drug classes will not count towards the member’s monthly six (6) prescription limit. The drug classes are as follows and include more than 500 medications.
- Systemic Antibiotics and Antivirals
- Anticonvulsants
- Behavioral Health Medications
- Cardiovascular Medications
- Diabetic Therapies
This prescription enhancement will help reduce ER visits and readmissions while lowering members’ out-of-pocket costs and reducing wait times for medication refills.
Medication Coverage and Cost Optimization
We have a large network to give members access to many types of pharmacies, including retail, mail-order, and specialty pharmacies. This makes it easy for you to get your medications. We work closely with our pharmacy programs to make sure they meet your needs as an Oklahoma Complete Health member.
Oklahoma Complete Health covers certain prescription drugs and over-the-counter (OTC) drugs when prescribed by an Oklahoma Complete Health provider. We do not cover all drugs. Some need prior authorization. Some drugs have limits on age, dosage, or quantities.
The Preferred Drug List (PDL) is the list of drugs covered by Oklahoma Complete Health. Oklahoma Complete Health asks that doctors prescribe medications from the Oklahoma Complete Health preferred drug list for their patients who are members of Oklahoma Complete Health. Some drugs will need your doctor to ask for prior approval before the medication can be given to you at the pharmacy. These drugs are on the prior approval list.
- Preferred Drug List (PDF)
- Drug Look-Up Tool (updated weekly)
- Brand required medications, covered over-the counter products, & diabetic supplies preferred list: OHCA Drug Lists
- 2026 clinical criteria regarding medications needing prior authorizations: OHCA PA Criteria
If a prescription you take is no longer preferred, you will be told by your doctor, Managed Care Plan, or pharmacy. You may need to switch to a different medication. You can also ask your doctor to ask for a prior authorization to stay on your current medication. If you get a letter in the mail from Oklahoma Complete Health, please read it carefully. You should talk to your doctor about it at your next visit or call your doctor’s office. If you try to refill your prescription before your next visit, the pharmacy may tell you that your medication needs prior authorization. We will work with your doctor to make sure you get the medication you need. You will not lose drug coverage. You will keep using the same Medicaid ID.
If you have questions or problems with your prescription, call Oklahoma Complete Health member services by dialing the toll-free number [1-833-752-1664] on your Medicaid ID card.
Specialty Pharmacy Services
A specialty drug is a prescription drug that needs special handling, administration, or supervising. These are often only ordered through a specialty pharmacy. Sometimes manufacturers limit which pharmacies can order their products. Oklahoma Complete Health allows all network pharmacies in our specialty pharmacy network, except for hemophilia medications.
A specialty pharmacy provides services and medications needed to treat members with chronic, complex, or rare conditions. The medication provided by specialty pharmacies is often considered high-touch or high-cost. The services provided by specialty pharmacies are done by highly trained professionals and are more extensive than regular retail pharmacies offer. Specialty pharmacy services can include clinical help, such as training on how to take medication, and financial support, like applying for copay assistance.
Through our specialty pharmacy services, we offer support for high-cost medications and complex therapies. We make sure you have access to the treatments you need with the guidance of a dedicated pharmacy team. Except for hemophilia medications, all other specialty medications are allowed at any network pharmacy. If your pharmacy is unable to fill a specialty medication for you and you need help obtaining the medication from an alternative pharmacy, please contact member services by dialing the toll-free number [1-833-752-1664] on your Medicaid ID card.
Fill and Receive Your Prescriptions
You can have your prescriptions filled at any network pharmacy. At the pharmacy, you will need to give the pharmacist your prescription and your Oklahoma Complete Health ID Card.To find a pharmacy that is in the Oklahoma Complete Health network, you can use the Find a Provider Tool. Type in your city or zip code. Then click Update. Choose Other and type the name of your pharmacy. You can also select the pharmacy type in the Select Specialty area. This will show a list of pharmacies in the Oklahoma Complete Health network.
Pharmacy Services
With our pharmacy partners, we take a tailored approach, adjusting solutions to the unique needs of providers and members. This approach enhances care coordination, improves clinical outcomes and lowers risks, fostering collaboration that drives better patient satisfaction and care delivery.
Over the Counter (OTC) Medications
Oklahoma Complete Health offers an added quarterly benefit that covers $30 per member for commonly used over-the-counter (OTC) items not covered through Oklahoma Complete Health’s Prescription Plan.
- Members may select from any items up to the $30 per quarter limit.
- Items on the list include, but are not limited to: cough, cold, and allergy medicines, antacids, and oral care.
- Members cannot return medication and products once received. If the order is not deliverable or not available, members are given a full return or replacement order.
- Balances do NOT carry over to the next quarter.
Our members can view the full catalog of items on our website and can order online (cvs.com/benefits), by phone (1-888-628-2770 (TTY 711), or pick up at any CVS Pharmacy.
Learn More
Get in Touch
If your pharmacy is experiencing a rejection & you need an immediate override, please have your pharmacy call our pharmacy helpdesks (open 24/7) at 1-833-750-3660 (SoonerSelect) or 1-833-750-3682 (Children's Specialty Plan).