What is a List of Preferred Drugs?What is the difference between brand name drugs and generic drugs?Are both brand name and generic drugs on the list?How does the List of Preferred Drugs work?Does the List of Preferred Drugs ever change?What is Step Therapy?Your benefit program defines the level of coverage.Prior authorization, questions, exceptions, appeals and forms. An alphabetical list of all the drugs on the List of Preferred Drugs.What is a List of Preferred Drugs?
The Medica List of Preferred Drugs is comprised of drugs that meet the medical needs of our members while providing the most value and have proven safety and effectiveness. It includes both brand name and generic drugs. The drugs on this list have been approved by the Food and Drug Administration (FDA). A team of physicians and pharmacists meets regularly to review and update the list. Your doctor can use this list to select medications for your health care needs, while helping you maximize your prescription drug benefit.
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What is the difference between brand name drugs and generic drugs? A generic drug is a copy of a brand name drug. The color or shape may be different, but the active ingredients must be the same for both. Generic drugs must meet the same quality standards as brand name drugs. The FDA sets these standards and reviews all drugs before they are marketed.
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Are both brand name and generic drugs on the list? Yes. The List of Preferred Drugs includes brand name and generic drugs from all therapeutic categories, providing access to a broad range of drugs.
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How does the List of Preferred Drugs work? Medica's List of Preferred Drugs is available on Medica's website, www.medica.com. If your doctor does not have access to the website, your doctor may call to request a copy of the List of Preferred Drugs through Medica's Provider Literature Request Line at 952-992-2355 or toll-free at 1-800-458-5512, option 8, ext. 2-2355 for those outside the Twin Cities Metro area. The List of Preferred Drugs will tell your doctor which drugs are covered for the most commonly prescribed drug categories. Only your doctor can make prescribing decisions for your medical treatment. This broad list of drugs provides your doctor with choices.
If you use a participating pharmacy and your prescribed drug is on the List of Preferred Drugs, the prescription will be billed and dispensed to you for your applicable copayment. If the prescribed drug is not on the List of Preferred Drugs you may be responsible for a higher copayment or the entire cost of the drug, depending on your benefit plan.
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Does the List of Preferred Drugs ever change?
Yes. A team of physicians and pharmacists regularly reviews new and existing drugs to be sure the List of Preferred Drugs remains responsive to the needs of our members and providers. Drugs may be added to the list upon review at anytime during the year, however Medica strives to remove products no more than twice each year. It is important to note that if a generic alternative becomes available for a brand name medication on our list of preferred drugs, the list may be updated more frequently to include the generic as the preferred drug.
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What is Step Therapy?
Step Therapy is a program focused on encouraging the use of cost-effective prescription drugs as first line treatment when therapeutically appropriate. This is one of the ways Medica can help clients and members manage the rising cost of healthcare.
Learn more about Step Therapy.
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Your benefit plan defines the level of coverage. Remember, just because a drug that you take is listed here does not mean that your benefit plan covers that medication in full. Also, you may have different copayments for drugs that are on the list of preferred drugs and drugs that are not. If you have questions, please refer to your benefit document or call the Medica Customer Service phone number on your ID card to determine what level of coverage you have.
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Prior authorization, questions, exceptions and appeals. – A prior authorization is when a request is submitted by a physician to Medica to authorize coverage for a certain drug and the request is approved. Prior authorizations are put into place due to the use for the medication and to help to ensure safety, effectiveness, and appropriate use for the medication. Medica physicians are notified of the drugs on the Medica List of Preferred Drugs which require prior authorization and are also informed of the process to obtain a prior authorization number. The Pharmacy and Therapeutics Committee at Medica has established criteria which must be met for these drugs to be covered.
Exceptions – There is a process for requesting a List of Preferred Drugs exception. Your physician may request an exception by calling 1-800-788-2949.
Appeals – If your exception request is denied, you do have the right to appeal. To appeal a decision, call Medica Customer Services at the number on the back of your Medica ID card and inform the representative that you wish to appeal a decision. Return to top.
Prior authorization and list of preferred drugs exception.
Print medication request forms.