Formulary/Drug Lists and Drug Coverage

 

What is a Formulary?

A Formulary, sometimes called a Covered Drug List, is a list of prescription drugs generally covered by your pharmacy benefit. MVP will generally cover the drugs listed in our Formulary as long as the drug is medically necessary, the prescription is filled at an MVP network pharmacy, and other plan rules are followed.

The Formulary was developed and approved by the MVP Pharmacy & Therapeutics (P&T) Committee.  The Committee is comprised of practicing physicians, representing a variety of medical specialties, practicing pharmacists and clinical health plan staff including medical directors and registered pharmacists. A physician and pharmacist with training and experience in the care of the elderly and disabled are also included on the Committee.

 

• Covered Drug Lists (Formularies & Updates)

  Individual Plan Formularies
  2018 Comprehensive Formulary (Updated 5/2018)
  2018 Abridged Formulary
  Formulary Changes
  2018 Formulario Comprensivo (actualizado 5/2018)
  
  Employer-Based Plan Formularies
  2018 Comprehensive Formulary (Updated 5/2018)
  2018 Abridged Formulary
  Formulary Changes
  
  Learn more about Part B drugs, diabetic supplies, and vaccine coverage
  
  

• Formulary Search Tools

  Use these tools to find out how your drugs are covered under your plan.
  
  BasiCare with Part D, WellSelect with Part D, and GoldSecure with Part D Plans
  GoldValue with Part D, Preferred Gold with Part D, and Gold PPO with Part D Plans

• Drugs With Restrictions (Prior Authorization,
  Quantity Limits, and Step Therapy)

  Pharmacy Management Programs - What are Prior Authorization, Quantity Limits, and Step Therapy programs?
  
  For certain prescription drugs, MVP Health Care has additional requirements for coverage or limits on our coverage. These requirements and limits ensure that our members use these drugs in the most effective way and also help us control drug plan costs. A team of doctors and pharmacists developed these requirements and limits for our Plan to help us to provide quality coverage to our members.
  
  Individual Plans
  Prior Authorization (PA):
  Drugs that require approval from MVP Health Care before you fill your prescription.
  
  Complete list of drugs that require a Prior Authorization for 2018.
  
  Quantity Limits (QL):
  Drugs with limitations on the amount MVP will cover.
  
  Complete list of drugs that have a Quantity Limit for 2018.
  
  Step Therapy (ST):
  In some cases, MVP Health Care requires you to first try one drug to treat your medical condition before we will cover another drug for that condition.
  
  Complete list of drugs that have a Step Therapy requirement for 2018.
  
  Employer-Based Plans
  Prior Authorization (PA):
  Drugs that require approval from MVP Health Care before you fill your prescription.
  
  Complete list of drugs that require a Prior Authorization for 2018 - Employer -based plan Formularies.
  
  Quantity Limits (QL):
  Drugs with limitations on the amount MVP will cover.
  
  Complete list of drugs that have a Quantity Limit for 2018 - Employer -based plan Formularies.
  
  Step Therapy (ST):
  In some cases, MVP Health Care requires you to first try one drug to treat your medical condition before we will cover another drug for that condition.
  
  Complete list of drugs that have a Step Therapy requirement for 2018 - Employer -based plan Formularies.
  
  

 

 

 

 

Last updated: October 2017

Important Information

 

MVP Health Plan, Inc. is an HMO-POS/PPO/MSA organization with a Medicare contract. Enrollment in MVP Health Plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

Out-of-network/non-contracted providers are under no obligation to treat MVP Health Plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Medicare beneficiaries may also enroll in Preferred Gold HMO-POS, GoldValue HMO-POS, GoldSecure HMO-POS, Gold PPO, BasiCare PPO, and/or WellSelect PPO through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.