PRESCRIPTION DRUG INFORMATION FOR PROVIDERS
All contracted providers in the Mercy Care Advantage network should receive a copy
of the Preferred Drug List (PDL) when you receive your updated provider manual each
year. However, the best place to find the most up to date PDL is on this Web site.
Click here
to view the latest formulary. For additional information and guidelines about the
PDL please review Chapter 17 of your provider manual.
Additionally there are several forms available below to assist you with a variety
of needs.
What is the Mercy Care Advantage Formulary?
A formulary is a list of drugs selected by Mercy Care Advantage in consultation
with a team of health care providers, which represents the prescription therapies
believed to be a necessary part of a quality treatment program. Mercy Care Advantage
will generally cover the drugs listed in our formulary as long as the drug is medically
necessary, the prescription is filled at a Mercy Care Advantage network pharmacy,
and other plan rules are followed. We contract with over 500 pharmacies in Maricopa
County and over 100 pharmacies in Pima county.
The formulary is continuously under review and as changes occur, the version on
the Web site is updated. The Web site has the most current and up-to-date version
available.
Please click
here
for information on prescription drug (Part D) benefits. (This information has been
taken directly from the MCA 2009 Evidence of Coverage)
For more detailed information about the Mercy Care Advantage prescription drug coverage,
please review the Mercy Care Advantage
Evidence of Coverage and other member materials, or contact Customer Service
at (800) 624-3879 24 hours a day, 7 days a week.
To verify Member eligibility for low-income subsidy, click on the link below.
http://www.cms.hhs.gov/PrescriptionDrugCovContra/17_Best_Available_Evidence_Policy.asp
Part D Information
Click
here to view monthly pharmacy updates.
Prescription Drug Exception and Appeals Process
Click HERE
Coverage Determination Request Form,
Click HERE
Appointment of Representative Instructions & Form,
Click HERE
LIS (Low Income Subsidy) Information,
Click HERE
Express Scripts, Inc. Payer information
( * this is only for providers),
Click
HERE
By clicking on the links above you may be leaving the Mercy Care Advantage website.
Links to other web sites are provided as a resource for our visitors.