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Pharmacy
Capstone Health Plan contracts with Partners Rx for pharmacy benefit management (PBM) services. Please review the links and documents provided under Resources on your right for additional information pertaining to pharmacy benefits for Capstone Members.
Partners Rx offers a comprehensive network of pharmacies nationwide. The pharmacy locator can be accessed through the Partners Rx web site.
Please be sure to refer to the Capstone Formulary prior to writing a Member's prescription. Whenever possible, prescriptions should be written for the generic equivalent per the formulary.
Non-Formulary Prior Authorization
To avoid the Member experiencing delays at the pharmacy, please contact Partners Rx to obtain a prior authorization when a non-formulary medication is prescribed. All non-formulary medications require a prior authorization to be obtained through Partners Rx using the Non-Formulary Authorization Request Form.
Complete the entire request form and fax to Partners Rx at: (800)-527-0531.
You may also contact Partners Rx to expedite your request at: (800) 711-4555.
Please obtain prior authorization approval before the patient goes to the pharmacy.
Mail Order Pharmacy
Partners Rx offers a prescription mail order service through Prescription Solutions. All maintenance medications must be filled through the mail order service. Please refer to the Mail Order Form for assistance in writing prescriptions for maintenance medications.
Pharmacy Limitations
- Capstone does not cover medications that are covered by Children's Rehabilitative Services (CRS). Prescriptions written by a CRS physician for a member enrolled in CRS are to be filled at the CRS pharmacy. CRS has a mail delivery service for members who cannot pick up the medications at the pharmacy. CRS covered medications are excluded from Capstone coverage, this includes prescriptions written for these medications by any physician, including the PCP. Please notify members to obtain their CRS covered medications from CRS.
- Thirty (30) day limitation on coverage of phsychotropic medications prescribed that is not covered by Capstone. Please see the Behavioral Health section of the Provider Manual for additional information regarding Capstone coverage of these medications.
