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- Part D Prescription Drug Benefit
- Drugs Covered by MCA
- Enrollee Request for Medicare Prescription Drug Coverage Determination(Electronic Version) (Click here for Printable Version)
- Low-Income Subsidy Information
- Monthly Drug Formulary Updates
- Part D Information
- Part D Grievance, Determinations and Appeals
- Medication Therapy Management Program
- Pharmacy Transition of Care
- 2012 Step Therapy Criteria
- 2012 Prior Authorization Criteria
- 2012 Quantity Limit Criteria
Your Part D Prescription Drug Benefits
As a Medicare beneficiary, you have the right to certain drug benefits. To learn more about your MCA coverage, follow the links below.
- Drugs Covered by MCA
- Enrollee Request for Medicare Prescription Drug Coverage Determination(Electronic Version) (Click here for Printable Version)
- Low-Income Subsidy Information
- Monthly Drug Formulary Updates
- Part D Information
- Part D Grievance, Determinations and Appeals
- Medication Therapy Management Program
- Pharmacy Transition of Care
Are there any restrictions on my coverage?
Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:
- Prior Authorization: Mercy Care Advantage requires you (or your physician) to get prior authorization for certain drugs. This means that you will need to get approval from Mercy Care Advantage before you fill your prescriptions. If you don’t get approval, Mercy Care Advantage may not cover the drug. 2012 Prior Authorization Criteria
- Quantity Limits: For certain drugs, Mercy Care Advantage limits the amount of the drug that Mercy Care Advantage will cover. For example, Mercy Care Advantage provides 90 pills in 30 days per prescription for Oxycodone HCL. This may be in addition to a standard one month or three month supply. 2012 Quantity Limit Criteria
- Step Therapy: In some cases, Mercy Care Advantage requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Mercy Care Advantage may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Mercy Care Advantage will then cover Drug B. 2012 Step Therapy Criteria
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Last Updated 12/20/2011