Nurse Advice Line

Did you know Medstar Family Choice-DC offers a FREE Nurse Advice Line?

If you’re feeling sick and/or need medical advice, call the Nurse Advice Line at
855-798-3540.

Registered nurses are available 24 hours a day / 7 days a week / 365 days a year to answer your healthcare questions and assess your symptoms.

Nurses can help you decide whether to call your doctor, go to urgent care, visit the ER, or treat your symptoms at home. All calls are answered live!

For medical emergencies, please call 911.

 

This program is funded in part by the Government of the District of Columbia Department of Health Care Finance.

MedStar eVisit

As a MedStar Family Choice-DC enrollee you are able to speak with a medical professional via video from the comfort of your home by using MedStar eVisit. Our MedStar eVisit providers are available to screen for COVID-19 risk, answer your questions, and help you with what to do if you’ve been exposed to COVID-19.

Click here to learn more about MedStar eVisit and Coronavirus.

Check "feel better" off your list with MedStar eVisit

See a Doctor Online 24/7 at No Cost to MedStar Family Choice-DC Enrollees!

What is MedStar eVisit?

  • MedStar eVisit gives you 24/7 video access to board-certified medical doctors. Making it easy to get the care you need, anywhere, anytime!
  • You can connect with a medical doctor via secured video from your tablet, smart phone, or computer for non-urgent medical conditions.

How does it work?

  • Download the MedStar eVisit app for your iOS (iPhone) or Android device. (Click on the hyperlinked text for your smartphone.)
  • Sign up by creating an account - it takes only a minute.
  • Select from the list of board-certified health care providers (doctors) who are available for consultation.
  • Connect with a doctor within minutes via secure video at home or on the go.
  • Your doctor will consult with you, diagnose, send a prescription, or help you with a referral as appropriate.

What type of conditions can MedStar eVisit treat?

  • Cold or flu-like symptoms
  • Seasonal allergies
  • Sore throat
  • Pink eye
  • Rash or hives
  • Nausea, vomiting, or diarrhea
  • Headaches or migraines Constipation
  • Dry skin
  • Sinus infection
  • Joint or back pain
  • Minor cuts or burns
  • Known urinary tract infections
  • Known yeast infection
  • Tick borne illness (Lyme)

When should I not use MedStar eVisit?

  • You should not use MedStar eVisit if you are experiencing severe flu symptoms and require an in-person evaluation.
  • These symptoms include difficulty breathing or shortness of breath, chest pain or discomfort, dizziness, confusion, severe or persistent vomiting, and/or flu-like symptoms that improve then worsen again.
  • If you are experiencing a medical emergency, please call 911 or visit your nearest emergency room.

How much does MedStar eVisit cost?

MedStar eVisit is available at no cost for all MedStar Family Choice-DC enrollees!

 

This program is funded in part by the Government of the District of Columbia Department of Health Care Finance.

Pharmacy Frequently Asked Questions

MedStar Family Choice District of Columbia (MFC-DC)
DC Healthcare Alliance
Frequently Asked Questions about Pharmacy

What is a Formulary?  

A formulary is a list of medicines. The MFC-DC Formulary is the list of medicines that are routinely available for members of MFC-DC. We say these medicines are “formulary” or “on the formulary.” Other medicines not on the list are called “non-formulary.” You can find a copy of the MFC-DC Formulary listing on this website. Your practitioner should be familiar with the medicines that are on the formulary. If you are prescribed a medicine by mistake that is not on the formulary, we will sometimes ask the prescriber to change the prescription to a formulary medication. If you need a medicine that is not listed on the formulary, there is a process for your practitioner to make a special request for it. If you are told by a pharmacist that MFC-DC will not allow your prescription to fill, you should contact your practitioner or MFC-DC and ask to start the process of a “Non-Formulary Medication Request.

How do I get help with a pharmacy problem?

You can call us from 8:00 a.m. to 5:30 p.m., Monday through Friday at 888-404-3549. If you need a medicine in an emergency when we are closed, please have the pharmacist call 855-210-6203 to get instructions on how to reach the pharmacy nurse on call.

What drugs need our approval?

A list of all the drugs that need our approval before they will fill at the pharmacy is in the front section of our ‘Formulary’ in the section called ‘Prior Authorization.’ Non-formulary medicines will need approval, too. Your practitioner will need to submit information to us to get the approval.

What does it mean if a medicine is on Step Therapy?

It means that MFC-DC expects you to have tried one medication (or more) before you can fill the medicine on the step therapy. For example, Sklice® is on step therapy. It is a brand name medicine used to treat head lice. There are other generic medicines on the formulary for treating head lice that MFC-DC would expect you to try before moving up to Sklice®. If you are having a problem filling a medication on step therapy you should call you practitioner or MFC-DC for assistance.

What does it mean when a medicine is an “over-the-counter” medicine? 

An over-the-counter medicine is a medicine that you can usually buy at a drug store without a prescription. Examples of over-the-counter medicines are aspirin, medicines for coughs and colds, ointments for rashes, and many others.

Are over-the-counter medicines covered?

Yes, there are a lot of these medicines on the formulary. There is a list of them in the front section of the “Formulary” document in the section called “Over-the-Counter (OTC) Drug Coverage.” You will need a prescription from your practitioner to use your MFC-DC card to pay for over-the-counter medicines. Your practitioner can write, call or fax the prescription to the pharmacy. There can be refills if your practitioner includes that with the prescription. Plan B emergency contraception for women and condoms do not need a prescription. Ask the pharmacist for help with which kinds are covered.

Which medicines are covered to treat HIV/AIDS?

Medications for the treatment of HIV and AIDS are supplied through the AIDS Drug Assistance Program (ADAP). All members must apply to the ADAP program and renew every 6 months. Prescriptions for HIV and AIDS medications must be filled at ADAP-participating pharmacies. Click here for a list of medicines available at ADAP Pharmacies.

What pharmacy can I use to get my HIV/AIDS medicines?

Click here for a list of participating ADAP (AIDS Drug Assistance Program) Pharmacies.

Does MedStar-DC cover HIV PrEP (HIV Pre-Exposure Prophylaxis)?

Prescriptions for PreP (HIV pre-exposure prophylaxis) may be filled at any in-network pharmacy. Please ask your practitioner to write on the prescription that the medicine is for PrEP as this will help the medicine process at the pharmacy more quickly.

What happens if I get a prescription for a medicine that is not listed in the Formulary?

If you need a medicine that is not listed, your practitioner will need to provide information to us by telephone (855-798-4244) or by fax (202-362-1393) about why you need a non-formulary medicine instead of a medicine on the formulary.

What happens if I get a prescription for a medicine that is not covered?

If a medicine is in the ‘not covered” group, MFC-DC will not pay for it. There are very few medicines that are not covered. Examples of medicines that are not covered are diet pills and medications for erectile dysfunction. If a medicine is not covered, you will have to pay for it.

Are there limits to prescriptions?

In general, medication can be filled for a one-month supply when filled at a retail pharmacy chain. However, members can fill a 90-day supply of most chronic medications at a retail pharmacy or they may use the Mail Order service through CVS to obtain a 90-day supply. A list of medications available in 90-day supplies (either by retail or through Mail Order) is available on the MFC-DC website.
Refills can be written for a maximum of twelve months. Some medications have quantity limits. This means that only a limited number of pills or tablets are allowed for a period of time. MFC-DC sets the limits based on the recommendations for safety from the Food and Drug Administration.

What if you need two prescriptions for the same medicine at the same time, for example, one for home and one for school?

You can obtain two prescriptions, but it is a special request. You should contact your practitioner. Your practitioner’s office needs to call us and we will approve the second medicine.

What if I am planning to go out of town for a long period of time?

You can have medicine for when you travel, but it is a special request. You practitioner’s office needs to call us. MFC-DC does not fill extra medicine for travel if the medicine is “controlled” [e.g. pain medicine/opioids, benzodiazepines (like Ativan or Valium), ADHD medicine, and many others]. There are exceptions if you have cancer, sickle cell, or are at the end of your life.

What if my medicine is lost or stolen?

If it is lost or stolen, you will need a new prescription. Your practitioner’s office needs to call us and we will replace the medicine. MFC-DC does not replace lost or stolen medicine if the medicine is “controlled” [e.g. pain medicine/opioids, benzodiazepines (like Ativan or Valium), ADHD medicine, and many others]. There are exceptions if you have cancer, sickle cell, or are at the end of your life.

Will the pharmacist give me a generic medication?

Yes, a pharmacist is required to give you a generic version of the medication if one is available. Generic medications contain the same active ingredient at the same dosage strength as a brand medicine. They are the same as the brand medication. The MFC-DC pharmacy network will only dispense generic medications with an “A” rating by the Food and Drug Administration. An “A” rating means that the generic drug has been tested and is equal in strength and safety to the brand medication.

How can I get a brand name medicine?

For MFC-DC to approve a brand name medicine when a generic version is available, your practitioner needs to send information about why you cannot take the generic medicine.

Can a therapeutic substitution be made by the pharmacist or by MFC-DC?

A therapeutic substitution is when a similar medicine is given to you by the pharmacy. Pharmacists in the District of Columbia are not allowed to perform a therapeutic substitution.

What should I do if I paid for a medicine myself but I think it should have been paid for with my MFC-DC card?

Sometimes, but not always, you can get your money back from MFC-DC. You can call us from 8:00 AM to 5:30 PM, Monday through Friday at 888-404-3549. We will review the situation and give you advice on what you need to do.

 

This program is funded in part by the Government of the District of Columbia Department of Health Care Finance.

New Provider Interest Form



 

This program is funded in part by the Government of the District of Columbia Department of Health Care Finance.

Find a Provider- DC Healthcare Alliance

We are currently in the process of developing our provider network. Providers who are interested in joining MedStar Family Choice District of Columbia should click here for more information. 

 
 

This program is funded in part by the Government of the District of Columbia Department of Health Care Finance.

For District of Columbia Providers

We are currently developing our website to ensure our providers have the most important and accurate information about our health plan.
If you are interested in participating with MedStar Family Choice District of Columbia, please click here. 
 

 

This program is funded in part by the Government of the District of Columbia Department of Health Care Finance.

Archive of Provider Alerts

Important Notice: As of October 1, 2017, the MedStar Family Choice contract to provide Medicaid services to residents in the District of Columbia has ended. Learn more >

Denial Codes and Reasons

Fraud and Abuse

While MedStar Family Choice monitors for possible fraud and abuse activities, we need your help to eliminate fraud and abuse. If you know of a situation that may involve fraud and abuse please report it immediately by calling the MedStar Family Choice Compliance Director at 888-404-3549. You may also contact Provider Relations at 202-243-5489 or call the Medstar Health Corporate Integrity Hotline at 877-811-3411. You may remain anonymous and all reports will be kept confidential. In addition, MedStar Family Choice enforces a non-retaliation policy for those individuals reporting possible fraud and abuse.

Fraud and abuse information for DC Healthcare Alliance Enrollees

Fraud and abuse information for DC Healthcare Alliance Providers

Synagis (palivizumab)

Important Notice: As of October 1, 2017, the MedStar Family Choice contract to provide Medicaid services to residents in the District of Columbia has ended. Learn more >

MedStar Family Choice follows the American Academy of Pediatrics 2014 guidelines for Synagis (palivizumab) administration (see link below). 

Requests for Synagis (palivizumab) require a completed 2016-2017 Synagis® Seasonal Respiratory Syncytial Virus Enrollment Form (see link below). Please fax completed forms to MFC at 202-243-5496.

If you have questions for MFC, call 855-210-6203.

Click here for the American Academy of Pediatrics 2014 Synagis (palivizumab) Guidelines.

Click here for the Synagis (palivizumab) Prior Authorization Form.