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 2011 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.

• Formulary
• Formulary Updates
• Adding a New Drug to the Formulary
• Mail Order Drugs
• Medication Therapy Management Program
• Out of Network Coverage
• Pharmacy Transition of Care
• Find a Pharmacy
• Pharmacy Coverage Determination Form
• 2012 Prior Authorization Criteria
• Specialty Medication Authorization Form
• 2012 Step Therapy Criteria
• 2012 Quantity Limit Criteria
• Comprehensive Formulary
• 2012 MCA Comprehensive Formulary

Prescription Drug Exception and Appeals Process Click HERE

Pharmacy Coverage Determination 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.