For example, if Drug A and Drug B both treat your medical condition, MVP may not cover Drug B unless you try Drug A first. 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. This limit may be applied to a standard one-month or three-month supply. For example, MVP provides one tablet per day for ZETIA. Quantity Limits (QL) For certain drugs, MVP Health Care limits the amount of the drug that we will cover. If you don t get approval first, MVP may not cover the drug. This means that you will need to get approval from MVP before you fill your prescriptions. Prior Authorization (PA) MVP Health Care requires you or your doctor to get prior authorization for certain drugs. These prescriptions can only be filled at a retail pharmacy. Not Available at Mail Order (NM) Certain drugs are not allowed through the mail order pharmacy program. Abbreviations and Definitions of Formulary Terms You may find one or more of the following abbreviations in the Formulary under the Requirements/Limits column next to a drug name. Please review this list before looking up your drug. Y0051_2315 Approved Formulary ID15217, Version 8Ģ PLEASE NOTE: Some of the abbreviations listed here have changed. Benefits, formulary, pharmacy network, and/or copayments/coinsurance may change on January 1, 2016, and from time to time during the year.
You must generally use network pharmacies to access your prescription drug benefit. Our contact information, along with the date we last updated the Formulary, appears on the front and back cover pages. This document includes a list of the drugs (Formulary) for our plans which is current as of August For an updated Formulary, please contact us. When it refers to plan or our plan it means GoldValue HMO-POS, Preferred Gold HMO-POS, Gold PPO, BasiCare PPO, GoldAnywhere PPO, USA Care PPO or MVP RxCare PDP. When this drug list (Formulary) refers to we, us, or our it means MVP. Please review this document to make sure that it still contains the drugs you take and to see if they have changed tiers since last year. TTY: Note to existing members: This Formulary has changed since last year. Or visit for the most up-to-date Formulary listing. 14 call seven days a week from 8 am 8 pm. This Formulary was updated in August For more recent information or other questions, please contact MVP s Medicare Customer Care Center Monday Friday, 8 am 8 pm Eastern Time at: From Oct. 1 MVP HEALTH CARE 2015 COMPREHENSIVE MEDICARE PART D FORMULARY (List of Covered Drugs) PLEASE READ: This document contains information about the drugs we cover in this plan.
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