McLaren Medicare plans have requirements for some drugs that need to be followed before we will cover them. These requirements are: prior authorization, step therapy, and quantity limits.
Note: Formularies effective as of April 11, 2024
Certain drugs require approval before we will cover them. Your doctor should contact us to receive this approval before prescribing you a drug that requires prior authorization or we will not cover it.
Drugs that require prior authorization 2024 - HMO/HMO-POS (pdf)
Drugs that require prior authorization 2024 - DSNP (pdf)
Sometimes, you will be required to first try another drug to treat your medical condition before we will cover the drug your physician initially prescribed. This is called step therapy.
Drugs that require step therapy 2024 - HMO/HMO-POS (pdf)
Drugs that require step therapy 2024 - DSNP (pdf)
Some drugs will have limits on the amount of the drug we will cover over a certain period of time. This is called having a quantity limit. This requirement is used for quality, safety, and utilization reasons.
Drugs that have quantity limits 2024 - HMO/HMO-POS (pdf)
Drugs that have quantity limits 2024 - DSNP (pdf)
You can also see which drugs have these requirements by looking at our online formulary or “Drug List”
To request coverage for a drug that requires prior authorization or to request an exception to one of these requirements, you can submit a request for a coverage determination or download the coverage determination form and return to:
By Mail: MedImpact Attn: Prior Authorization 10181 Scripps Gateway Ct San Diego CA 92131 By Fax: 858-790-7100
MedImpact Attn: Prior Authorization 10181 Scripps Gateway Ct San Diego CA 92131
By Fax:
858-790-7100