Pharmacy

NH Healthy Families offers tailored clinical programs that are customized to drive medication adherence and reduce medication errors. These programs are designed to improve health outcomes by supporting members in managing chronic conditions and ensuring they receive the right medications at the right time to get and stay healthy.       

Pharmacy Value Flyer (PDF).       

Medication Therapy Management: Our Medication Therapy Management programs support members in understanding and managing their medications, helping to optimize their health regimens and improve therapeutic outcomes.

Our pharmacy program leverages an extensive network, which provides access to a wide range of retail, mail-order, and specialty pharmacies, ensuring our members receive their medications conveniently and cost-effectively. We work closely with our pharmacy program to prioritize transparency in pricing, reduce the total cost of care, promote value, and ensure affordability for NH Healthy Families members. Members have the option to receive a 90-day supply of their maintenance medications at in-network pharmacies.

NH Healthy Families covers certain prescription drugs and over-the-counter drugs when prescribed by a NH Healthy Families provider. The pharmacy program does not cover all drugs. Some require prior authorization. Some drugs have limitations on age, dosage or maximum quantities.

The Preferred Drug List (PDL) is the list of drugs covered by NH Healthy Families. NH Healthy Families works with NH DHHS, providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. The PDL applies to drugs that members receive from retail pharmacies. The PDL is continually evaluated by the Pharmacy and Therapeutics Committee to promote the appropriate and cost-effective use of medications.

Click the links below to view the NH Healthy Families Preferred Drug List (PDL) documents:

View the Preferred Drug List (PDF).

Machine-Readable File (JSON)

• NH Healthy Families Preferred Drug List Machine Readable File (JSON)
  In accordance with the CMS Transparency in Coverage Final Rule (84 FR 65524), NH Healthy Families has made public the preferred drug list in a machine-readable file format (MRF).
  

NH Healthy Families Medical and Pharmacy Policies.

NH Healthy Families Prescription Prior Authorization FAQ’s (PDF).

Submit a secure electronic Prior Authorization request for any of the below forms through Cover My Meds.

Pharmacy Services processes pharmacy claims for self-administered (i.e. oral, self-injectable, topical, ophthalmic) drugs. For self-administered medications, submit a secure electronic Prior Authorization request through Cover My Meds or use the medication request form(s) below:

• Medication Prior Authorization form (PDF)
• Specialty Medication Request Form (PDF)
• Behavioral Health Prior Authorization Form for Community Mental Health Center Providers (PDF)

1-877-250-5227

Access to Specialty Medications: Through our specialty pharmacy services, we offer support for high-cost medications and complex therapies, ensuring members have access to the treatments they need with the guidance of a dedicated pharmacy team.

Your Preferred Specialty Pharmacy is AcariaHealth

AcariaHealth is a national specialty pharmacy dedicated to transforming lives through compassionate care. They focus on enhancing the health and outcomes of people with complex medical conditions. AcariaHealth
takes a collaborative approach to care, working closely with providers and their offices to tailor treatment programs to meet members’ unique needs.

AcariaHealth provider services include:

• Single point of contact (Provider Experience Managers)
• Support with referral and prior authorization processes
• Web-based collaboration and enhanced communication

How to Send a Prescription Referral:

AcariaHealth

• E-prescribe: Find AcariaHealth in your electronic medical records (EMR) system.
• Phone: Dial 800-511-5144 Ext 608-0033 to speak directly to our pharmacists.
• Fax: Send completed referral form via fax to 877-541-1503.
• Download our referral forms.

Contact AcariaHealth

P: 1-800-511-5144 (TTY 711)
F: 1-877-541-1503

customercare@acariahealth.com

Learn more about AcariaHealth.

Comprehensive Medication Review Medication List and Patient Takeaway Template (PDF)

As a pharmacy serving NH Healthy Families members for New Hampshire Medicaid plans, you can earn revenue for providing Medication Therapy Management (MTM) services, such as a Comprehensive Medication Review (CMR) that empower your patients to effectively manage their medications and health.

How it works:

• Outcomes® shares CMR-eligible patients for your review and action.
• You document the results of your intervention in the free OutcomesOne online platform.
  
• Your pharmacy earns revenue for helping an eligible patient improve adherence to their medication regimen by completing a comprehensive medication review.
  

To take advantage of this opportunity:

1. Go to Outcomes Contracting.
   
   • Complete the contracting form for your pharmacy.
2. Outcomes will contact you to help you complete setup for your pharmacy and access your CMR-eligible patients. 
3. Document the results of your MTM services in the OutcomesOne platform.

There is no cost to participate with Outcomes. For help getting started, call the Outcomes help desk at 1-877-237-0050, Monday through Friday, 8 a.m. to 8 p.m. EST. We look forward to working with you to improve medication outcomes for your patients. For additional information please reach out to NH Healthy Families at 1-866-769-3085, Monday through Friday 8 a.m. to 5 p.m. EST.

Get in Touch: For more information about our pharmacy program, contact us at: 1-866-769-3085 TDD/TTY: 1-855-742-0123.