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Pharmacy Services

The Staywell Kids Plan Covers Drugs Required by Medicaid.

But we also want you to know that we use a Preferred Drug List (PDL). The PDL is a list of drugs we prefer your doctor use. The drugs on the PDL are arranged by brand and generic name.

Search for a drug using our online tool. You can also view or print the PDL.

Search for a Drug

Drug Evaluation Request Forms


  • A Staywell Kids doctor must write or approve prescriptions
  • They must be picked up at a pharmacy that is part of the plan network (A list of such pharmacies is in your provider directory)
  • Prescription drugs the plan covers are on the PDL (Doctors, pharmacists and nurses make this list)

Staywell Kids Plan Documents

Fill out and submit this form to request prior authorization (PA) for your Medicaid prescriptions.

Fill out and submit this form to request an appeal for Medicaid medications.

A preferred drug list is a list of drugs covered by your plan.

This is a list of changes to our preferred drug list (PDL).


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Last Updated On: 2/19/2016