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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
Prescription Drug Transition of Care
When you join Mercy Care Advantage and you learn that we do not cover a prescription drug you were taking before you joined our Plan, you may be able to get a one temporary fill of a 30-day supply of that prescription drug (or less, as prescribed). You and your doctor will then get a letter from our pharmacy benefits manager, Express Scripts, notifying you that you will need to get a prescription for a formulary drug or request an exception with the help of your doctor.
If you are a new member and live in a long-term care facility, you may be able to get multiple temporary fills of a 31-day supply (or less, as prescribed) of your prescriptions during your first 90 days. You and your doctor will then get a letter from our pharmacy benefits manager, Express Scripts, notifying you that you will need to get a prescription for a formulary drug or request an exception with the help of your doctor.
If you have been a member for more than 90 days and are requesting a refill of a drug that is not on our formulary, we will require information from your doctor showing that you have used the drug for 6-8 weeks prior to requesting the refill. If the request is supported, you may be able to get a one temporary 30-day supply of that prescription drug (or less, as prescribed). You and your doctor will then get a letter from our pharmacy benefits manager, Express Scripts, notifying you that you will need to get a prescription for a formulary drug or request an exception with the help of your doctor.
If you are a long-term care facility resident, and have a change in your level of care (e.g., moving from one facility to another or from a facility to home), you may be able to get temporary, 31-day supplies of prescription drugs not on our formulary (or less, as prescribed). You and your doctor will then get a letter from our pharmacy benefits manager, Express Scripts, notifying you that you will need to get a prescription for a formulary drug or request an exception with the help of your doctor.
4350 E. Cotton Center Blvd.,
Bldg D, Phoenix,
Arizona 85040
Member Services
Available 24 hours per day, 7 days a week
602-263-3000,
Toll-free 1-800-624-3879
(TTY/TDD)
Toll-free: 1-866-602-1982
If you or a family member has a medical emergency, dial 911.
Last Updated 12/20/2011