Abbreviations and Definitions of Formulary Terms

You will find the following terms and abbreviations in our Covered Drug List (Formulary)

Not Available at Mail-Order (NM)
Medicare Part D drugs that are not available through the CVS Caremark Mail Service Pharmacy.

Prior Authorization (PA)

MVP Health Care requires you or your doctor to get prior authorization for certain drugs. This means that you will need to get approval from MVP Health Care before you fill your prescriptions. If you dont get approval first, MVP Health Care may not cover the drug.

Quantity Limits (QL)

For certain drugs, MVP Health Care limits the amount of the drug that MVP Health Care will cover. For example, MVP Health Care provides one capsule per day for DEXILANT. This limit may be applied to a standard one-month or three-month supply.

Step Therapy (ST)

In some cases, MVP Health Care 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, MVP Health Care may not cover drug B unless you try Drug A first. If Drug A does not work for you, MVP Health Care will then cover Drug B.

Dispensing Limits (DL)

Certain drugs are limited to a 30-day supply through a retail pharmacy and are not available through the mail order pharmacy.

Limited Availability (LA)

Some medications are available only through a designated Specialty Pharmacy because of manufacturer limited distribution.

Part B versus Part D drug coverage (B/D)

Some drugs could be covered under the Part B or Part D benefit, depending on your situation. This means that you or your doctor will need to submit a request to MVP Health Care so we can determine, based on Medicare guidelines, if your drug will be covered as Part B or Part D. Your cost sharing will be based on this determination.

Last updated: October 2016