What is a Drug Formulary List?What is the difference between brand name drugs and generic drugs?Are both brand name and generic drugs on the list?How does the Formulary Drug list work?Does the formulary ever change?Your benefit program defines the level of coverage.Prior authorization, questions, exceptions, appeals and forms. An alphabetical list of all the drugs in the formulary.
What is a Drug Formulary List?The Medica Formulary is a list of generic and brand name outpatient prescription medications that 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.
What is the difference between brand name drugs and generic drugs?
A generic medication is basically a copy of a brand name medication. The color or shape may be different, but the active ingredients must be the same for both. Generic medications must meet the same quality standards as brand name medications. The FDA sets these standards and reviews all medication before they are marketed.
Are both brand name and generic drugs on the list?
Yes. The Formulary includes brand name and generic drugs from all therapeutic categories, providing access to a broad range of medications.
How does the Formulary Drug list work?
Medica's Formulary 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 Formulary 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 Formulary will tell your doctor which medications 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 Formulary, the prescription will be billed and dispensed to you for your applicable copayment. If the prescribed drug is not on the Formulary you may be responsible for a higher copayment or the entire cost of the drug, depending on your benefit design.
Does the formulary ever change?
Yes. The team of physicians and pharmacists regularly reviews new and existing medications to be sure the Formulary remains responsive to the needs of our members and providers throughout the year.
Your benefit program defines the level of coverage.
Remember, just because a medication that you take is listed here does not mean that your benefit program covers that medication. Also, you may have different copayments for fomulary or non-formulary medications as stated above. If you have questions, please refer to your benefit materials or call the Medica Customer Service phone number on your ID card to determine what level of coverage you have.
Prior authorization, questions, exceptions and appeals. - Prior Authorization - to ensure appropriate utilization, drugs noted with "PA required" must be reviewed prior to being covered. Medica physicians are notified of the drugs on the Medica Formulary which require prior authorization and are also informed of the process to obtain a prior authorization number. The Pharmacy and Therapeutics Committee has established criteria which must be met for these drugs to be covered. If your condition meets the criteria, an authorization number will be issued and relayed back to your physician.
- Exceptions - There is a process for requesting a formulary 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 1-800-952-3455 or 952-945-8000, or TTY 1-800-841-6753 or 952-992-3190 and inform the Medica Representative that you wish to appeal a decision.
Forms --
print medication request forms for prior authorization or formulary exceptions.