IMPORTANT CHANGES TO HIV/AIDS MEDICATION COVERAGE: On January 1, 2020, HIV/AIDS medicines will no longer be paid for by the State of Maryland Fee-For-Service. Instead, individual Managed Care Organizations (like MedStar Family Choice) will manage and pay for HIV/AIDS medicines for their members. MedStar Family Choice created an “open” formulary for HIV/AIDS medicines that will be effective 1/1/2020. What this means is that all FDA approved HIV/AIDS medications are included on the formulary and available to our members. Additionally, MedStar Family Choice does not charge a copay for medication. As such, members will notice that they no longer have a copay at the pharmacy for their HIV/AIDS medicine(s).
MedStar Family Choice has approved a wide variety of prescription medications available for our physicians to prescribe. MedStar Family Choice also pays for many over-the-counter (OTC) medications.
MedStar Family Choice covers a 90-day supply of most chronic medications at retail pharmacies and through mail order. Click here for more information on medications available for a 90-day supply and how to register MedStar Family Choice members for mail order pharmacy.
Approved drugs are listed in the sections below:
- MedStar Family Choice Formulary
- Recent Formulary Updates - a comprehensive list of formulary changes made at each quarterly Pharmacy and Therapeutics Committee meeting.
- Formulary Quick Reference
- Covered OTC Medication List
- Prior Authorization Table - a comprehensive listing of all medications requiring prior authorization with criteria necessary for approval.
- Step Therapy Table - a comprehensive listing of all medications requiring step therapy.
- Hepatitis C Medication (Harvoni, Sovaldi, etc.) Prior Authorization Information
- Synagis Prior Authorization Information
- Opioid Prior Authorization Requirements
For those medications that require prior authorization, please submit a request (see link below for the form) to MedStar Family Choice. Requests must include clinical documentation that supports the medical need for the specific medication. Physicians may call MedStar Family Choice at 410-933-2200, of fax requests to 410-933-2274.
If a physician feels it medically necessary to prescribe a medication not on the formulary, the physician may submit a request (see link below for the form) to MedStar Family Choice. Requests must include clinical documentation that supports the medical need for that specific medication. Physicians may call MedStar Family Choice at 410-933-2200, or fax requests to 410-933-2274.
There are certain categories of medications that are covered by the Maryland Department of Health. Mental health medications and some seizure medications are not the responsibility of MedStar Family Choice. Please review the Maryland Department of Health preferred drug list for the listing of covered medications.
A list of mental health medications can be found on the Maryland Department of Health Medicaid Pharmacy Program website. For mental health medications, please use the link entitled “Mental Health Formulary.” For substance abuse medications, please use the link entitled “Substance Use Disorder Medication Criteria.”
To send a maintenance prescription to CVS Caremark Mail Service Pharmacy for your patient, please complete the form below and fax to the number on the form. Or e-Prescribe to CVS Caremark Mail Order Electronic, NCPDP ID 322038, 9501 East Shea Blvd, Scottsdale, AZ 85260.
For the most up-to-date pharmaceutical recall information, please visit the U.S. Food and Drug Administration website at https://www.fda.gov/Drugs/DrugSafety/DrugRecalls/default.htm.
For additional information, please see the Provider Frequently Asked Questions.