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.
Effective January 1, 2021, Maryland Managed Care Organizations will be responsible for payment for several high cost medications. These medications are expected to cost over $400,000 annually. MedStar Family Choice (MFC) will require Prior Authorization (PA) for these medications regardless of place of service. Prescribers MUST contact MFC before administration. Failure to do so will result in non-payment. Post-administration retrospective requests for authorization will not be accepted for review. Click here to learn more.
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
- 90-Day Supply 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 Prior Authorization Information
- Makena (17-alpha hydroxyprogesterone caproate, also known as 17P)
- Synagis Prior Authorization Information
- Opioid Prior Authorization Requirements
For those medications that require prior authorization or for non-formulary medication requests, 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.”
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.