Pharmacy and Prescription Information

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.

High-Cost Medication List - MedStar Family Choice (MFC) will require Prior Authorization (PA) for high-cost medications regardless of place of service (i.e., PA is required in ALL outpatient and inpatient settings). High-cost medications are expected to have an annual cost of greater than $500,000 per year. 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. WITHOUT PRIOR AUTHORIZATION, YOU WILL NOT BE REIMBURSED. NO EXCEPTIONS.

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 and Step Therapy: a comprehensive listing of all medications requiring prior authorization and step therapy with criteria necessary for approval.

• Hepatitis C MDH Clinical Criteria 

• Synagis Requirements 

• Opioid Requirements

• Makena (17-alpha hydroxyprogesterone caproate, also known as 17P) 

  FDA approval of Makena and all generic forms of 17-alpha hydroxyprogesterone caproate injection (17-OHP), was withdrawn on April 6, 2023. 

  Please refer to the American College of Obstetricians and Gynecologists (ACOG) guidance regarding the use of progesterone for the prevention of preterm birth that can be found in ACOG Practice Bulletin No. 234, “Prediction and Prevention of Spontaneous Preterm Birth” (linked here) for additional information.

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.

 

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.

 

Prior Authorization Forms:

 

• Hepatitis C Medication Prior Authorization Form

• Opioid Prior Authorization Form

• Synagis Prior Authorization Form

• General Medication Prior Authorization Form

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 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.