In our Prescription Drugs Formulary, you will find a variety of drugs we cover. This drug list, selected by MCS Classicare and a team of healthcare professionals, includes the drug therapies necessary for a quality treatment program. Generally, MCS Classicare will cover the drugs included in the formulary provided if they are necessary for the medical treatment, are obtained in one of our network pharmacies, and 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.
HRM - This medication is considered high risk for people aged 65 years and older.
LA – Limited Access.
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:
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 coverage limits. These requirements and limits may include:
Prior authorization (PA)
MCS Classicare requires prior authorization for certain drugs. This means that you will need to get approval from MCS Classicare before filling the prescriptions. If you 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 you 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 based on 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 the 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 addendum includes the changes made to the formulary during the calendar year for MCS Classicare members who are enrolled in the following plans: