Find Pharmacies in your area:
Elixir pharmacy staff are available 24 hours a day at 1-844-222-5584
Approved Drug Lists – Updated as of 05/04/2021
Below are approved drug lists by benefit plan:
Commercial – Includes employer-sponsored plans
- 2-Tier Commercial Approved Drug List
- 3-Tier Commercial Approved Drug List
- 4-Tier Commercial Approved Drug List
- 4-Tier Commercial High Deductible Health Plan Approved Drug List
- 4-Tier Commercial High Deductible Health Plan Chronic Condition Enhanced Prescription Drug List
- 2-Tier Alternative List for Non-covered Drugs
- 2-Tier Search By Drug Name
- 3-Tier Search By Drug Name
- 4-Tier Search By Drug Name
- 4-Tier High Deductible Health Plan Search By Drug Name
Qualified Health Plan – Includes healthcare.gov, Individuals & Families, and SHOP
Healthy Michigan Plan
Note: Effective 7/01/2016, THC has transitioned to Michigan’s Common Drug Formulary. For further information, click here
- Total Health Care’s Healthy Michigan Payer Sheet, which includes RxBIN (610342) and PCN (ROIRX) Billing
- Healthy Michigan Plan Approved Drug List
- Healthy Michigan Search By Drug Name
- Healthy Michigan Alternative List for Non-covered Drugs
Medicaid
Note: Effective 7/01/2016, THC has transitioned to the State of Michigan’s Common Approved Drug List. For further information, click here
- Total Health Care’s Medicaid Payer Sheet, which includes RxBIN (610342) and PCN (ROIRX) Billing
- Medicaid Approved Drug List
- Medicaid Alternative List for Non-covered Drugs
- Medicaid Children’s Special Health Care Services (CSHCS) Approved Drug List
- Medicaid Search By Drug Name
Approved Drug List Changes
Exception Requests
Email Exception Request: pharmacy@thcmi.com
Please include Member Name, Member ID, Member Phone #, Drug Name, Prescribing Doctor’s Name, Prescribing Doctor’s Phone # and Exception Request Information.
Total Health Care Member Information
Pharmacy Benefit Information
Members may obtain the following information through Elixir:
- Determine their pharmacy benefit financial responsibility
- Order a refill for an existing mail order prescription (Applies only to Commercial, 3 – Tier & Qualified Health Plan Approved Drug Lists)
- Locate an in-network pharmacy
- Conduct a pharmacy proximity search based on zip code
- Provide information on drug-drug interactions
- Provide information on common side effects and risks of a drug
- Provide information on generic alternatives
Mail Order Form (Commercial, 3 – Tier & Qualified Health Plan Approved Drug Lists)
Total Health Care offers a ninety (90) day prescription mail delivery service for certain maintenance medications through a mail order program administered by Elixir’s affiliate company, Elixir Mail.
Mail delivery order forms are available by clicking here, or at envisionpharmacies.com (registration is necessary) or by calling the Pharmacy Department at 1-800-826-2862, extension 3617.
