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Providers' Frequently Asked Questions about Pharmacy

How do I get help with a pharmacy problem?

MSFC has nurses dedicated to pharmacy services. They can be reached from 8:30 AM to 5:00 PM, Monday through Friday for routine, non-emergency issues. Information may be submitted either by telephone (410-933-2200 or 800-905-1722) or by fax (410-933-2274.) For emergencies after hours, please call 1-800-905-1722, select the pharmacy option from the menu and follow the instructions to page the on-call person.

What drugs are on Prior Authorization?

A list of all the drugs that require prior authorization is in the front section of the MSFC Formulary.

Does MSFC cover over-the-counter medications?

Yes, there are a variety of commonly used over-the-counter medications on the formulary. They are listed in the front of the formulary booklet in the "Over-the-Counter Drug Coverage" section. A prescription, written or telephoned, is required and refills are permitted. Plan B for women over the age of 18 does not require a prescription. By State Medicaid rules, condoms do not require a prescription.

What drugs are on Prior Authorization?

A list of all the drugs that require prior authorization are listed in the front section of the MSFC Formulary.

What do I need to do to obtain an authorization for a medication on Prior Authorization?

The first step should be to review the criteria in the MSFC Prior Authorization Protocol for the medication. All of the Protocols are available on this website. Paper copies are available upon request. If your patient meets the criteria, submit the information to MSFC either by telephone (410-933-2200 or 800-905-1722) or by fax (410-933-2274.). If the criteria are not met, be prepared to support the request with additional information and/or ask to speak to the Physician Advisor to discuss the issue. For emergencies after hours, please call 1-800-905-1722, select the pharmacy option from the menu and follow the instructions to page the on-call person.

What happens if I write a prescription for a non-covered medication?

Most non-formulary medications can be filled one time as an "Emergency Three Day Override" by the pharmacy staff. If you have a patient who needs a non-formulary medication for a chronic condition, you will need to request a "Medical Exception." To request a Medical Exception, submit the information to MSFC either by telephone (410-933-2200 or 800-905-1722) or by fax (410-933-2274.) Be prepared to offer a medically appropriate reason why a formulary medication cannot be prescribed. For example, the member has tried the formulary medication(s) but developed intolerable side effects.

Are there limits to prescriptions?

In general, the supply of medication that can be dispensed at one time is limited to a one month supply. Refills can be written for a maximum of twelve months. Some medications have additional restrictions, also called Managed Drug Limitations (MDL). There is a list of the drugs with an MDL in the front section of the formulary along with the limit. To request an override, submit the information to MSFC either by telephone (410-933-2200 or 800-905-1722) or by fax (410-933-2274.)

What if I have a patient who needs two prescriptions for the same medication at the same time - one for home and one for school?

The second prescription will automatically be rejected by the pharmacy computer as exceeding a one month's supply. You must contact MSFC at 410-933-2200 or 800-905-1722 so that the pharmacy nurse can create a manual override.

What if I have a patient who is planning to go out of town for a prolonged period of time?

The early prescription will automatically be rejected by the pharmacy computer as either an early refill or because it exceeds a one month's supply. You must contact MSFC at 410-933-2200 or 800-905-1722 so that the pharmacy nurse can create a manual override.

MSFC will only approve future medications for members whose enrollment segment shows coverage continuing in to that future time span. For example, if it is May and the member is requesting medication while traveling in June, the member must be an active member of MSFC in June. If the member's enrollment span ends on May 31, MSFC will only approve medication through May 31 and will not approve medication for the month of June. Travel prescriptions will be limited to a 30 day supply.

What if medication is lost or stolen?

If it is lost or stolen, you will need to re-issue a prescription. The early prescription will automatically be rejected by the pharmacy computer as either an early refill or because it exceeds a one month's supply. You must contact MSFC at 410-933-2200 or 800-905-1722 so that the pharmacy nurse can create a manual override.

If the medication is a controlled substance, MSFC will expect that the theft has been reported to the police and ask for a police report number. It is also likely that the pharmacy nurse will contact you to confirm that you have indeed re-issued a control substance prescription.

How can I get a brand name medication dispensed?

Under Maryland pharmacy law, the pharmacist is required to dispense the generic version of a medication. A practitioner needs to make a notation on the prescription such as "brand medically necessary" or "no generic substitution" as a message to the pharmacist to dispense the brand name medication.

For MSFC to approve the dispensing of a brand name medication when a generic version is available, the practitioner must submit information either by telephone (410-933-2200 or 800-905-1722) or by fax (410-933-2274) showing that the branded product is medically necessary. MSFC will encourage the practitioner to file an FDA Medwatch form.

Can a therapeutic substitution be made by the pharmacist or by MSFC?

No, therapeutic substitution is not permitted under Maryland pharmacy law.

I just got a call from a pharmacist telling me that they are getting a rejection message for a "Step Therapy." What does that mean?

The MSFC Pharmacy and Therapeutics Committee has determined that in some cases prescribing drugs in a particular order is appropriate. The medications on Step Therapy are listed in the front section of the formulary. Where the drug is listed within the formulary you will see the notation "ST" next to the drug name and a notation of what drug is recommended first. MSFC expects the medications to be prescribed in the order of the step therapy. If following the recommended sequence is not appropriate for the member, submit information either by telephone (410-933-2200 or 800-905-1722) or by fax (410-933-2274) explaining why.

If the patient filled the first drug using their MSFC pharmacy benefit, the computer will automatically process the second drug. If the patient has tried the first line drug in the past but the pharmacist is still getting a rejection message then the computer system does not have the prior prescription. Often that is because the member was your patient but not yet a member of MSFC, or they filled the first prescription under another insurance or paid for it themselves.

How can I get a medication added to the MSFC Formulary?

You may request an addition to the MSFC formulary by contacting the MSFC Medical Director by telephone (410-933-2200 or 800-905-1722) or by fax (410-933-2274.)

Who decides what medications are on the MSFC Formulary?

There is a MSFC Pharmacy and Therapeutics Committee that includes practitioners and pharmacists. The Committee meets 4-6 times a year. It makes decisions about the medications on the formulary, sets policy, determines the criteria for authorization and other duties. If you would like to learn more about the Committee or join the Committee, please contact the Medical Director either by telephone (410-933-2200 or 800-905-1722) or by fax (410-933-2274.)

This page was last updated on 03/07/14

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