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NH Healthy Families is committed to providing appropriate, high-quality, and cost-effective drug therapy to all NH Healthy Families members. NH Healthy Families covers prescription medications and certain over-the-counter medications with a written order from a NH Healthy Families 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 our Medicaid Preferred Drug List (PDF) to find more information on the drugs that are covered.

Prior Auth Criteria

Expand the sections below to determine which medication request is appropriate for the different types of prescriptions.

Click to view the NH Healthy Families Pharmacy PA Criteria.

US Script, NH Healthy Families' Pharmacy Benefit Manager, processes pharmacy claims for self-administered (i.e. oral, self-injectable, topical, ophthalmic) drugs. For self-administered medications, use the medication request form below

To complete this form electronically please visit

Pharmacy Help Desk:

Monday - Friday 8:00 am - 9:00 pm EST
Saturday 9:30 am EST - 6:00 pm EST 

Specialty medication requests will go to NH Healthy Families. To submit a request for medications that will be administered by a provider (i.e. specialty, home health, outpatient, injectable or infusible medications), use the form below. If you can’t find the specialty drug you are looking for, click here.