Pharmacy and Prescription Services

Keystone First Community HealthChoices covers medicines that are:

• Medically necessary.
• Approved by the U.S. Food and Drug Administration (FDA).
• Prescribed by your health care provider*.

Copays may apply to prescriptions.

How does the pharmacy benefit work?

When you need medicine or over-the-counter items, your health care provider will write a prescription for you to take to the pharmacy. The following areas will help you learn more about where to get your medicine, which medicines are covered, and reimbursement for medicines.

• Find a pharmacy
  This tool will help you find a pharmacy that takes Keystone First CHC in your area.
• Find a specialty pharmacy (PDF)
  This document will help you find a pharmacy in the Keystone First CHC network.

Find a medicine

• Dual-eligible Participants: Please refer to the drug list of your Medicare Part D plan.
  • If you have Keystone First CHC as a secondary coverage, use our list of covered over-the-counter medicines. You can also view the printable version (PDF) here.
  • If you have Keystone First VIP Choice, use our Medicare Part D formulary. 
• Medicaid LTSS Participants:
  • Pennsylvania Medical Assistance Program Preferred Drug List (PDL) (includes PDF of DHS PDL).
  • Keystone First CHC Searchable Formulary
  • Keystone First CHC Supplemental Formulary (PDF)
  • Machine-readable formulary. (TXT)
  • 90-Day Supply Medication List (PDF)
    Some medicines may be filled for a 90-day supply. Talk with your doctor or pharmacist if you have questions about your medicines.

Other pharmacy information

• Reimbursement for medicine.

There may be times when you pay for your medicine. Keystone First Community HealthChoices (CHC) may reimburse you, or pay you back.

• Prescription medicines.

Prescription medicines are prescribed by your health care provider to help keep you healthy, or treat you when you are sick. Copays may apply.

Please call Participant Services at 1-855-332-0729 (TTY 1-855-235-4976) if you have questions.