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Prescription Drug List
Our Prescription Drug List is a list of prescription medications, including brand name and generic medications, that have been approved by the United States Food and Drug Administration (FDA) as safe and effective. It is a tool that helps guide you and your doctor in choosing medications that allow the most effective and affordable use of your pharmacy benefit. The Prescription Drug List is subject to review and modification.
Remember, your pharmacy benefit plan determines your out-of-pocket
costs. Here are some general guidelines for a standard three-tier pharmacy
plan:
- Tier 1 is your lowest copayment option.
- Tier 2 is your middle copayment option.
- Tier 3 is your highest copayment option.
For a quick overview of our Prescription Drug Lists, use the links below. Please check your Pharmacy Benefit Plan to verify your benefit.
Pharmacy Online
Log on to Pharmacy Online to:
- View your Prescription Drug List
- Order maintenance medications
- View your pharmacy claims
- Learn more about prescription medications
Important Notice
If you receive your pharmacy benefits through a Maryland employer with 2 to 50 eligible employees, the policies listed below apply to you.
- Prescription Medications Requiring Prior Authorization
Certain prescription medications are classified as maintenance
medications, meaning they are anticipated to be required for six months or more to
treat a chronic condition. Because these medications are used for longer
periods of time, we evaluate and approve them a little differently.
If a medication is not on our list of prescription maintenance
medications, but your doctor writes a prescription for more than a one-month supply,
your doctor must request authorization to prescribe the medication as a
prescription maintenance medication. Ask your doctor to submit medical documentation,
including diagnosis and any relevant treatment information, to the Pharmacy
Services Department. (He or she can call 1-800-205-3636 for more information.)
You may still obtain a one-month supply of the medication while your doctor is
seeking approval.
Optimum Choice, Inc. (OCI) and MAMSI Life and Health Insurance Company (MLH)
members with pharmacy benefits through a Maryland employer with 2 to 50 eligible employees must first fill
a new maintenance prescription for a 30/31-day supply (or less) when purchasing at retail or through
mail-order. Only after this fill may the member obtain a 90-day supply at retail or through mail-order.
You may want to ask your doctor to write two prescriptions – one for a 30/31 day supply and one for a
90 day supply. Once you know the medication is working for you with the 30/31 day supply, you can then
fill the 90 day supply going forward.
To see the prescription maintenance medication list,
click here. This list is subject to
change.
- Quantity level limits
- Injectable Drugs Requiring Prior Authorization
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Question? Members may call our Member Services Department at
the telephone number listed on their health plan identification card.
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