HAP Empowered MI Health Link has a large network of pharmacies in your area. We also have a large number of pharmacies across the United States. You must use a pharmacy in the network. We only cover prescriptions from an out-of-network pharmacy if you’re traveling outside the area and there’s no network pharmacy. If you use a pharmacy not in the network, you may have to pay and get paid back from HAP Empowered.
The pharmacy and provider network may change throughout the year. We’ll send you a notice before we make a change.
To find a network pharmacy, call Customer Service at (888) 654-0706 (TTY: 711), seven days a week, 8 a.m. to 8 p.m.
To have a directory mailed to you, call Customer Service at (888) 654-0706 (TTY: 711), seven days a week, 8 a.m. to 8 p.m.
To get this information free in formats such as large print, Braille, or audio, call Customer Service at (888) 654-0706 (TTY: 711), seven days a week, 8 a.m. to 8 p.m.
To make a standing request to get all materials in a language other than English or in an alternate format, call Customer Service.
Medication Therapy Management
You’re eligible if you:
- Use eight or more drugs
- Will spend more than $4,044 on drugs in 2019
- Have at least three of these qualifying medical conditions: acid (reflux and ulcers), Alzheimer’s disease, anemia, arthritis, atrial fibrillation, benign essential tremor, benign prostatic hyperplasia, bipolar disorder, cardiovascular disorders, cerebrovascular disease, chronic heart failure, Crohn’s disease, dementia, depression, diabetes, dyslipidemia, end-stage renal disease, hepatitis C, HIV and AIDS, hypertension, incontinence, insomnia, multiple sclerosis, neurological disorders, osteoporosis, Parkinson’s disease, plaque psoriasis
If eligible, we’ll mail a letter. It’ll be about the program and its potential benefits. An analyst will call you to ask questions. You can set up a phone appointment with a pharmacist.
You don’t need to change doctors or pharmacies.
Log in to review your HAP Pharmacy Claim History.
Pharmacy and drug information
Learn if your drug has coverage restrictions or limits
HAP Empowered MI Health Link has special rules for some drugs. This means that you or your doctor must take extra steps for us to cover the drug. Some drugs require approval before we cover the drug. For some drugs, we want you to try certain drugs before we cover that drug. This is called step therapy. Some drugs have quantity or age limits.
You can find all limits or restrictions by searching the drug list. To search, press Ctrl+F (Command+F for Mac) and type in the name of the drug. If your drug is on the list, the drug will be highlighted. You can see if there are limits or restrictions. If your drug is not on the list, you can ask us for an exception. If your drug has other restrictions or limits, you can ask for an exception.
You or your doctor can request an exception:
- if your drug is not on the list
- if the drug has a limit or restriction
If we approve a request for a drug not on the list, or we waive limits or restrictions, the drug will be covered at no copay.
Doctor’s supporting statement for a formulary exception
If you or your doctor requests an exception, we need a statement from your doctor verbally, or in writing. The statement tells us the medical reasons why you need the drug. The doctor may cite one or more of these reasons:
- At least two of the covered drugs on any tier of the drug list available for treatment of your condition won’t be as effective as the nonformulary drug and/or would be harmful for you.
- The alternatives on our list of drugs we want you to try first were not effective for you, or they have already caused you harm, or might cause you harm.
- The number of doses in our limit were not effective in treating your condition. Or your doctor thinks they won't be as effective.
Request an exception
To request an exception or prior authorization, use the Medicare Part D Coverage Determination Request Form (PDF).
Your doctor must sign the form and send it to us. Your doctor should include all important medical information that supports the request. For example, chart notes, lab information. Your doctor should mail it to:
HAP Empowered MI Health Link
Attn: Pharmacy Care Management
P.O. Box 2578
Detroit, MI 48202
Fax: (313) 664-5460
We will send you a letter to let you know if we approved the request, and for how long.
We will also send you a letter if we deny your request.
You have the right to request an appeal.
Prior authorization, step therapy and generic substitute
Prior authorizationYou must get approval before we cover the drug. We might need health information from your doctor. It may be a diagnosis for lab results. If you don't get prior authorization, we might not cover the drug.
Step therapyWe ask you to try one drug before we cover some other drug. If drug A and drug B both treat your health condition, your doctor may need to order drug A first. If drug A doesn’t work, we’ll cover drug B.
Generic substituteIf there’s a generic version of a brand-name drug, our drugstores will give it to you. If your condition calls for you take the brand, your doctor must ask for approval.
Transition supply policy
We have a transition program the same as 42 CFR §423.120(b)(3). It makes sure you have access to covered drugs.
We may give you a temporary supply of a drug. This is when your drug is not on the list or is limited in some way. This gives you time to talk to your doctor about getting the different drug or asking us to cover your drug.
To get a temporary supply of a drug, you must meet these rules:
- is no longer on the list
- was never on the list
- now has limits
For Medicare Part D drugs:
- you were in the plan last year
- you are new to the plan
- you have been in the plan for more than 90 days and live in a long-term care place and need the drug right away
For Michigan Medicaid drugs, you are new to the plan. You can work with your doctor to choose a new drug or for an exception.
Current enrollees affected by drug list changes from one contract year to the next.