In our Prescription Drugs Formulary you will find a variety of drugs we cover. This list of drugs chosen by MCS Classicare, in agreement with a team of healthcare providers, includes the drug therapies necessary for a quality treatment program. Generally, MCS Classicare will cover the drugs included in our Formulary provided: they are necessary for the medical treatment, are obtained in one of our network pharmacies, and they follow all other rules established by the plan. For more information regarding how to get your medications, please review the Evidence of Coverage of the plan of your choice.
The following symbols in the Requirements/Limits column tell you if MCS Classicare has any special coverage limitation for your drug:
MO - Mail Order.
PA – Prior Authorization
QL – Quantity Limit
ST – Step Therapy
EXCL – Excluded Drugs.
FFQL – First Fill Quantity Limit.
NeDS – Non-Extended Day Supply.
PA BvsD - The prescription drug requires prior authorization and may be covered under the medical benefit.
The Prescription Drug Formularies contain information that may change during the year.
The following Prescription Drug Formulary provides a list of drugs we cover for MCS Classicare members who are enrolled in the following plans:
Are there any restrictions on the formulary?
Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:
Prior Authorization (PA)
MCS Classicare requires prior authorization for certain drugs. This means that members will need to get approval from MCS Classicare before filling the prescriptions. If members don’t get approval, MCS Classicare may not cover the drug.
Drugs that require a preauthorization are identified in the Prescription Drugs Formulary with the letters (PA).
Step Therapy (ST)
In some cases, MCS Classicare requires the member to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and B both treat your medical condition, MCS Classicare may not cover Drug B unless you try Drug A first. If Drug A does not work for you, MCS Classicare will then cover Drug B.
Formulary Addendums
MCS Classicare may add or remove drugs from our formulary during the year according to the clinical decisions made by our Pharmacy and Therapeutics Committee. Below you will find the updated lists of the prescription drugs that have been removed, added or whose criteria has changed in our Prescription Drug Formularies. For example, if the medication requires prior authorization, if there was a change in its quantity limits, its step therapy restrictions or if the drug was moved to a higher copayment or coinsurance level, among others.
The following Prescription Drug Formulary Addendum provides a variety of drugs we cover for MCS Classicare members who are enrolled in the following plans:
The following Prescription Drug Formulary Addendum provides a list of drugs we cover for MCS Classicare members who are enrolled in the following plans:
Your pharmacy benefit lets you fill your prescription drugs in an MCS-participating pharmacy or through the Drug Mail Order Program. This program offers you a comfortable and economic way to request up to a 90- day supply for maintenance drugs. To learn more about this program press here