Please be advised that exceptions have been made to the six prescription limit through the State Plan benefit for adults receiving services through the ADvantage Home and Community Based Services Waiver.
ADvantage Waiver Members are eligible through the State Plan benefit for six covered prescriptions per month, with a limit of two brand name prescriptions. Members are also eligible for seven prescription medications per month through the ADvantage prescription benefit. In addition, seven medically necessary generic prescriptions per month are allowed through SoonerCare. These additional medically necessary prescriptions, beyond the 2 brand name or 13 total allowed prescriptions for ADvantage Members, are covered with Prior Authorization (prior approval by SoonerCare). For questions regarding Prior Authorization of medications, contact the SoonerCare Helpline at 1-800-987-7767.
If you have any questions or concerns regarding the information provided above, please feel free to contact us via email at Provider Questions.