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Pharmacy Benefits

MedStar Family Choice Formulary

The MedStar Family Choice Formulary (PDF) is the list of drugs (medications) that has been approved by our pharmacy committee. The list has a very wide selection to ensure that we can meet the many healthcare needs of our members.

If you are currently taking a medication that is not listed in the MedStar Family Choice Formulary, you should speak with your doctor about changing to a similar medication that is on the formulary. If your medication is not on the formulary and your doctor believes it is medically necessary, he or she will need to call our Care Management Department for approval.

If you would like us to consider your non-formulary medication, please click here.

  • Effective July 1, 2017, the MedStar Family Choice Plan Drug Benefit will change. Lantus® and Levemir® insulin will no longer be available on our list of covered drugs. There are two other insulins your doctor can choose as alternatives. Click here for more information.

To see a full list of recent changes to medications covered by MedStar Family Choice, click on this Recent Formulary Changes link.

Pre-authorization Process

In addition, some medicines on the formulary require approval from MedStar Family Choice before they can be filled. Your doctor has a list of the medicines that require approval. If the pharmacy is unable to fill the medication because there is no approval from MedStar Family Choice, you should call your doctor and have him or her contact our Member Services Department at 1-888-404-3549.

If you already know that the medicine you are taking requires approval from MedStar Family Choice and you need a refill, you should contact your doctor during normal business hours and let him/her know that you will need a refill and it requires approval from MedStar Family Choice.

We recommend that you make the call to your doctor and make sure that the approval has been given before you make a trip to the pharmacy. This will ensure that your medication is ready when you are ready to pick it up.

Residents of Washington D.C. living with HIV/AIDS now have a dedicated pharmacy network established to give out anti-retroviral drugs to the District’s Medicaid beneficiaries. Click for list of ADAP Pharmacy Directory.

Please be advised that effective January 1, 2013, the Department of Health Care Finance (DHCF) will reimburse only those pharmacies participating in the new District of Columbia Pharmacy Provider (DCPP) Network for anti-retroviral drugs. All other prescriptions can be filled at any participating managed care pharmacy.

In order for this process to be effectively implemented, your support is crucial. We strongly encourage you to promptly distribute and display the District of Columbia Pharmacy Provider (DCPP) Network Directory at your facility.

You may also access the current directory via the website at www.doh.dc.gov click on the HIV/AIDS.

If you have any further questions regarding the new District of Columbia Pharmacy Provider (DCPP) Network program, please feel free to contact Charlene Fairfax, RPh, Senior Pharmacist at (202) 442-9076 or [email protected].

Over-the-Counter Medications

MedStar Family Choice does pay for some over-the-counter medications. In order to receive these medications using your MedStar Family Choice card, your doctor must write a prescription or call the prescription in to your pharmacy. Your doctor is able to include a limited number of refills on the prescription so that you do not have to call your doctor each time you run out of one of these medications. These medications are available as generics (not name brand).

Copays

There are no copays for medicines paid for by MedStar Family Choice. MedStar Family Choice is always your secondary insurance. You should tell your doctor that you have two types of insurance so that he/she can make sure the medicine he/she prescribes is approved by both of your insurance companies. If you have other insurance, you should give both cards to the pharmacist. Your other insurance will pay for the drug and MedStar Family Choice will pay for any copay you may have.

Pharmacy Network

Most large pharmacy chains and grocery stores are included in our network. For example, CVS, MedStar Pharmacies, Giant, Safeway, and Walgreens, are included in our network. There are numerous other chains and independent pharmacies that are in our network as well. If you are out of town, keep in mind that numerous national chains are in our network. If you have a question about a specific pharmacy, please call Member Services at 1-888-404-3549.

To find the location of an in-network pharmacy online, click Find a Provider or use the search bar at the top of the page. The Find a Provider website enables users to find pharmacies by specifying their location and selecting Pharmacy under the Facility Type drop down menu.

Contacting MedStar Family Choice for Pharmacy Concerns

You can always call MedStar Family Choice Member Services for any pharmacy issues. We are available Monday through Friday 8:00 a.m. – 5:30 p.m. Our After Hours Nurse Line is also available at 855-210-6203. If your pharmacy has a problem filling your prescription, we encourage you to ask the pharmacist to call MedStar Family Choice Member Services at 888-404-3549. The pharmacist will be able to tell us what type of error is occurring. If for some reason your pharmacy is unable to call us, it is very important that you get the actual reason that the prescription cannot be filled. The pharmacy will have an error message that describes the reason and can provide that to you. Once you have this information you should call our Member Services Department for assistance. Also make sure that you have the name and phone number of the pharmacy, the name and phone number of the doctor prescribing your medicine, and the name of the medicine. This information is very important in ensuring that we provide you with the best possible service.

Pharmacy FAQs

MedStar Family Choice Formulary

Information current as of: 06/19/17