Questions about your medicines*
What medicines are covered by Keystone First?
Keystone First covers many prescription medicines and some over-the-counter medicines.* Talk with your health care provider, your pharmacist, or Member Services to find out if a medicine is covered. We make changes and add new medicines to the list of covered medicines from time to time. To get the most current list, go to Find a Doctor, Medicine, or Pharmacy or call Member Services.
Keystone First must approve some medicines before you can get them. This is called prior authorization. Prior authorization is a way to make sure you get medicines that are proven to work and are right for you.
Are there any limits to the medicines covered by Keystone First?
Yes, the limits are:
- There are limits to the amount of medicine dispensed at one time.
- The medicine must be medically necessary.
- The medicine must be covered under the Pennsylvania Medical Assistance program.
Does Keystone First cover over-the-counter (OTC) medicines?
Yes. Keystone First covers some OTC medicines if you have a prescription. Prescriptions are given only when you have a medical need for them. Some examples of OTC medicines covered by Keystone First are:
- Cough syrup
- Sinus and allergy medicines
- Pain medicine, such as acetaminophen, naproxen, and ibuprofen
- Heartburn medicine, such as antacids, cimetidine, and ranitidine
- Prenatal vitamins (vitamins for when you are pregnant)
Do all pharmacies accept Keystone First?
Most pharmacies in your area accept Keystone First. Ask your pharmacist to see whether it is part of the Keystone First pharmacy network. Or you can call Member Services to get a list of the pharmacies in your area that accept Keystone First.
* You must be eligible for pharmacy benefits under Medical Assistance to receive these benefits.
**There could be a co-pay for some of your medicines.