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.
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.
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