MHS Health Wisconsin is committed to providing appropriate, high-quality, and cost-effective drug therapy to all MHS Health Wisconsin members. MHS Health Wisconsin covers prescription medications and certain over-the-counter medications with a written order from a MHS Health Wisconsin provider. The pharmacy program does not cover all medications. Some medications may require prior authorization and some may have limitations. Other medically necessary pharmacy services are covered as well.
BadgerCare & SSI
The pharmacy benefit for members of BadgerCare Plus (Standard, Benchmark and Core plans) and Medicaid SSI is managed by the state of Wisconsin, with the exceptions of Synagis and Hylan agents.
For all other medications, please call the state provider services line at 1-800-947-9627.
Allwell from MHS Health Wisconsin
Allwell from MHS Health Wisconsin HMO SNP provides a "captive" pharmacy benefit through Envolve Pharmacy Solutions. To request a coverage determination please submit your request on the forms below.
- Prescriber Request for Medicare Prescription Drug Coverage Determination (PDF)
- Medicare Part B Drug Prior Authorization Request Form (PDF)
For further information, please contact:
Provider Network Questions: Envolve Pharmacy Solutions Help Desk
Claims Processing Customer Service: Envolve Pharmacy Solutions