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a. Prescription drugs for members in levels 1 and 2a are limited to drugs from manufacturers who have signed a federal rebate agreement. b. Prescription drugs for members in levels 2b and 3 are limited to drugs from manufacturers who have signed a SeniorCare rebate agreement with the state of Wisconsin. 6. Drugs that have not been dispensed from a pharmacy. If a member chooses to purchase a prescription that is not covered under SeniorCare, they are responsible for the cost at the pharmacy’s retail price and it will not count towards their spenddown and/or deductible. SeniorCare provides medication therapy management (MTM) services. The MTM services are provided by the pharmacist to answer the member’s questions about the drugs they get. The goal of MTM services is to help the member understand more about the drugs they take, make sure they are taking their drugs properly, and make sure they are only taking drugs they need. 33.16.2 Discount Pricing The discount for a particular drug during the deductible period will be the same at every pharmacy. During the deductible period, the pharmacy must use the SeniorCare allowed price. Exception: If a pharmacy’s usual and customary charge is less than the SeniorCare allowed amount, then the member would be charged the usual and customary charge and this amount will apply to SeniorCare spenddown and/or deductible. 33.16.3 Early Refills When the member is temporarily leaving the state and the supply on their prescriptions is insufficient, they will need to make arrangements with the pharmacist to have any additional refills mailed or have someone else pick-up the refill. Postage costs are not covered by SeniorCare, nor do they count toward the deductible and/or spenddown. Requests for early refills will be denied. 33.16.4 Out-of-State Pharmacies In an emergency, a member can get a prescription filled out of state and have it count toward SeniorCare as long as the member is within the US, Canada, or Mexico and the pharmacy completes the necessary forms. Out-of-state pharmacies should contact 1-800-947-9627 to file a claim for reimbursement. Non- emergency prescriptions will be covered only when prior authorization has been granted. This page last updated in Release Number: 26-03 Release Date: 08/12/2026 Effective Date: 08/12/2026 34.1 Emergency Services 34.1.1 Emergency Services Eligibility Introduction Emergency Services Medicaid is a limited benefit for immigrants who do not qualify for other forms of Medicaid because of their immigration status.