Pharmacy
Delaware First Health is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Delaware First Health members. Delaware First Health covers prescription medications and certain over-the-counter medications with a written order from a Delaware First 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.
Use the Preferred Drug List or the Formulary to find more information on the drugs that are covered.
Medicaid Pharmacy Policies
Medicaid Prior Auth Criteria Search
Please use the search function or select View All to locate the drug specific Delaware First Health prior authorization form that should be used when submitting an authorization request.
Express Scripts, Delaware First Health’s PBM, processes pharmacy claims. Centene Pharmacy Services administers the pharmacy prior authorization process.
Retail Prior Authorization Fax: 1-844-233-6130 (Pharmacy Services)
Medical - Pharmacy Prior Authorization Fax: 1-833-938-0826 (Pharmacy Services)
Clinical Hours: Monday-Friday: 6:00 AM - 12:00 AM EST
Saturday-Sunday: 8:00 AM – 8:00 PM EST
The Maintenance Drug Program provides details of the products that can be dispensed as part of this benefit.
Members can also obtain a 100 day supply (3 month supply) of their maintenance medications from participating retail maintenance drug pharmacies or CVS Mail Order.
To find a pharmacy that is in the Delaware First Health network, you can use the Find a Provider tool.
See Clinical and Payment Policies page for more information.
Maximum Allowable Cost (MAC) pricing is available through the Express Scripts Pharmacy Benefit Manager (PBM) website. Participating pharmacies can visit the Express Scripts Pharmacist Resource Center. To access, log in is required.