Medica Commercial and SPP Formulary Structure: The List of Preferred Drugs, Formulary drug benefit and Nonformulary drug benefit.
Utilization Management Programs: Prior authorization, Step Therapy and Quantity Limits.
Noncovered Services: Prescriptions that are excluded from coverage.
Network Pharmacies: Choice 90 Retail Pharmacy Program, Mail Order and Specialty Drug Program.
Medicare Part D
Formulary Structure: Medicare Part D List of Preferred Drugs currently offered by Medica to members.
Utilization Management Programs: Prior Authorization, Step-Therapy and Quantity Level Limits.
Coverage Determinations: Standard Part D Coverage Determination Requests, Urgent Part D Coverage Determination Requests and Right to Appeal on Denials.
Transition of Care: Medica provides a transition of care period for all new Medica Part D members.
Prescription & Over-the-Counter Wrap Benefits: Prescription & Over-the-Counter Wrap Benefits, Medicare Part B Pharmacy Drugs and Over-the-Counter Drugs.
Excluded Part D Drugs: Categories of medications generally excluded by Medicare Part D.
Return to Provider Administrative Manual.