Pharmacy / Prescription Drug Benefits
Covered Services Summary
Covered Benefits, Limitations, Exclusions
All Health Care District enrolled members are eligible for prescription medication coverage. Simply present your prescription, your Membership card and your identification to any of the participating pharmacies. Please refer to the District’s contracted Pharmacies Provider Directory. The Health Care District will pay for drugs listed on the Coordinated Care Pharmacy Formulary (PDF 136.8KB), an approved list of medications. If a prescription is written for a drug that is not on the approved list, then you may have to return to your Primary Care Physician to have the prescription changed to a similar drug that is on the formulary.
The following drugs and supplies are covered:
- Prescription drugs on the Health Care District Coordinated Care Pharmacy Formulary (PDF 136.8KB) (approved list).
- Prescription refills up to one year from the original date of the prescription (up to six (6) months on controlled substances); based on eligibility status and practitioner’s refill authorization.
- $2.00 co-pay is required for each approved generic prescription obtained at a retail pharmacy (co-pay does not apply to Option 3 members).
- $5.00 co-pay is required for each approved brand prescription obtained at a retail pharmacy (co-pay does not apply to Option 3 members).
- Prescription drugs will only be covered up to a maximum 30-day supply for retail prescriptions.
- A selection of maintenance medications are available as a 90-day supply at HCD pharmacies.
- Generic must be dispensed, unless the product is not available in a generic form.
- Certain drugs may only be dispensed at the Health Care District pharmacies located in the Palm Beach County Health Centers, as shown on the formulary.
- A select group of non-formulary medications such as chemotherapy drugs may only be provided by the Health Care District pharmacy; (see list below).
- Select diabetic supplies may only be provided by the Health Care District pharmacy; (see list below).
- All drugs that are not listed in the Health Care Districts’ Pharmacy Formulary (PDF 136.8KB) (approved list).
- Infertility medication.
- Chemotherapy drugs unless prior authorized.
- Rogaine (Minoxidil) for hair restoration.
- Medications that are not medically necessary or medically appropriate.
- Inpatient drugs.
- Drugs that are not recommended or approved for general use by the Food and Drug administration.
- Drugs that are experimental or investigative.
- Medications that are dispensed by a non-participating pharmacy.
- Prescriptions refilled in excess of the amount specified by the physician.
- Appetite suppressants or any drugs for weight control.
- Refilling of a prescription before its refill date or one-year after issuance,(6 months for controlled drugs).
- Therapeutic devices or appliances, support garments, and other non-medicinal substances, unless prior authorized.
- Any medication therapy related to benefits exclusions listed in the Member or Provider Handbook.
- Lost or stolen medications.
Health Care District Pharmacy Locations
Hours for Delray Beach, Lantana and West Palm Beach: Monday - Friday 8:00 am - 5:00 pm
Hours for Belle Glade: Monday - Friday, 8:30 am – 5:00 pm, closed for lunch 12:30 pm–1:00 pm
All pharmacies open on Saturday: 9:00 am - 1:00 pm
A complete listing of retail pharmacy locations can be found in the Provider Directory (PDF).