Pharmacy Services

At AlohaCare we are committed to providing appropriate, high-quality, and cost-effective drug therapy to all AlohaCare members. With our partners, we provide innovative and tailored pharmacy solutions, improving member health outcomes by ensuring access to essential medications, cost effective treatments and personalized clinical programs.

AlohaCare 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.

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

Our Pharmacy program uses a large network to give members access to many types of pharmacies, including retail, mail-order, and specialty pharmacies. This makes it easy for members to get their medications. We work closely with our pharmacy programs to make sure the needs of our AlohaCare members are met. AlohaCare covers certain prescription drugs and over-the-counter drugs when prescribed by an AlohaCare 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 AlohaCare. AlohaCare asks that doctors prescribe medications from the AlohaCare preferred drug list for their patients who are members of AlohaCare. Some drugs will require a prior approval request before the medication can be given to the member at the pharmacy. These drugs are on the prior approval list.

• CCS:  Searchable | PDF | Machine Readable

View QUEST (Medicaid) Pharmacy Services Page

Prior Authorization Request Request a prior authorization or file an appeal of a drug coverage decision.

You must file your appeal within 60 days from the date you get your Notice of Adverse Benefit Determination. You can file by calling or writing to us. If needed, we can help you file your appeal. You can also get help from others. Your provider or someone else you approve (in writing) to act for you can help. AlohaCare Appointment of Representative form.

For Appeal Requests for Medical Services:

Call Member Services toll-free at 1-1-877-973-0712 (TTY 711). Fax to us at 808-973-2140 or write to us at:

AlohaCare
Attn: Grievance and Appeals Department
1357 Kapiolani Blvd Ste G101
 Honolulu, HI 96814

For Appeal Requests for Pharmacy Medications:

Call Customer Service toll-free at 1-877-973-0712 (TTY 711). Fax to us at 808-973-2140, or write to us at:

AlohaCare
Attn: Grievance and Appeals Department
1357 Kapiolani Blvd Ste G101
 Honolulu, HI 96814

Or complete the AlohaCare Drug Coverage Request Form online.

We will send you a letter within 5 business days from when we get your appeal. This letter will let you know we got it. We will then review it and send you a letter within 30 days telling you of our decision. You or someone you choose to act for you can review all of the information we used to make the decision.

You may appeal a prior authorization denial decision by contacting our Grievances and Appeals department.

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. Prescribers have the option to have the prescriptions be filled at any willing specialty pharmacy provider of their choice.

Optum Specialty Pharmacy 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.  Optum Specialty Pharmacy takes a collaborative approach to care, working closely with providers and their offices to tailor treatment programs to meet members’ unique needs.

While Optum Specialty Pharmacy is your preferred specialty pharmacy provider, prescribers have the option to request that prescriptions be filled by any willing specialty pharmacy provider of their choosing.

• Optum Specialty Pharmacy
• E-prescribe: Find Optum Specialty Pharmacy in your electronic medical records (EMR) system.
• Phone:  1-855-215-0235
• Fax: Send completed referral form via fax to 1-877-342-4596
• Download Referral Forms
• Contact Optum Specialty Pharmacy
• Phone: 1-855-427-4682
• Fax: 1-877-342-4596

Learn more about Optum Specialty Pharmacy at Optum Specialty Pharmacy .

Sometimes, certain medications are not available through Optum Specialty Pharmacy. For example, some medications are only available at other pharmacies in a limited distribution network. In these cases, we will cover medications through a different specialty pharmacy.