Pharmacy

For Pharmacy forms, please go to our Forms page.

  • VA Medicaid 90-Day Drug List Update

    The Department of Medical Assistance Services (DMAS) is pleased to announce that a new permanent policy allowing coverage of a maximum 90-day supply of many maintenance drugs will be implemented on 10/1/2021. The list of eligible maintenance drugs includes many highly utilized medications on the DMAS Preferred Drug List, which members typically receive for long-term therapy. Members will be eligible for this policy after receiving two 34-day or shorter fills of drugs on this list. This new maintenance list is not all inclusive. If a member’s medication is not on the maintenance list, they may receive a maximum 34-day supply of their prescriptions.

    At the beginning of the COVID-19 crisis, DMAS provided short-term flexibilities to cover a maximum 90-day supply of all drugs, excluding schedule II medications. This flexibility was only effective for the duration of the public health emergency which expired on 6/30/2021. DMAS has provided a 60-day transitional period after the end of the public health emergency that will end on 9/30/2021.

    We’re excited to take lessons learned during the beginning of the COVID-19 crisis and translate them into permanent policies to ensure access and convenience for our members. The 90-day supply drug list may be accessed at https://www.virginiamedicaidpharmacyservices.com/provider/external/medicaid/vamps/doc/en-us/VAMPS_90-day_supply_list.pdf.

     

  • Preferred Drug List

    MCC has a list of covered drugs that are selected by us with the help of a team of doctors and pharmacists.

    This list of covered drugs also includes all the drugs on the DMAS Preferred Drug List (PDL). The list includes which drugs are covered by us and tells you if there are any rules or restrictions on any drugs, such as a limit on the amount a member can get.

    MCC will pay up to $50 per quarter for select over-the-counter (OTC) products for members with an active prescription from a participating provider. These products can include:

    • Vitamins
    • Cough and cold medicines
    • Antihistamines
    • Antacids
    • Artificial tears
    • Topical antibiotics
    • Antifungals
    • Gastrointestinal medicines

     

    Please review this list to find out what drugs are covered by MCC. If you would like a paper copy of the list of covered drugs, please call us and we will mail a copy to you. Please be aware that this list may change throughout the year.

    • Commonwealth Coordinated Care Plus (CCC Plus): (800) 424-4524
    • Medallion 4.0: (800) 424-4518

     

    If you prescribe a drug that is impacted by a change to the list of covered drugs, you will be notified in writing 30 days prior to the change taking effect.

    List of covered drugs

  • Drug Recalls
  • MCC Specialty Pharmacy Program

    MCC is committed to providing you and your patients with access to quality services and cost-effective prescription drugs. Magellan Rx Pharmacy, LLC through their Magellan Rx Specialty division, provides specialty pharmacy services to your patients.

    What this means to you and your patients

    Prescription drug requests for specialty medications for MCC members need to be submitted to Magellan Rx Pharmacy for fulfillment. Your patient may call Magellan Rx Specialty Pharmacy at (866) 554-2673 to discuss opting out of this program and have his or her current specialty pharmacy continue to provide the medication.

    Our current Prior Authorization (PA) process will stay the same. Patients with an existing authorization will not need to request a new PA until the current authorization has expired.

    Services and programs to help patients stay on your treatment plan

    With Magellan Rx, your patients have access to the following specialty services:

    • Insurance specialists to help get the most out of benefits
    • Coordination of medication, including delivery to your office or patient’s home
    • Important supplies at no additional cost, such as syringes and needles
    • Highly trained pharmacists and nurses available toll-free to answer any questions
    • Online member portal to request refills and learn more
    • Access to community resources

     

    To submit a prescription, or if you have questions, please contact Magellan Rx Pharmacy at (866) 554-2673.

  • J Code Prior Authorization Changes

    See a list of prior authorization requirement changes effective May 1, 2021 

    See a list of prior authorization requirement changes effective October 1, 2020 

    These medications require prior authorization effective September 1, 2020

    Please refer to the prior authorization list for a complete list of medications and services that require prior authorization.

  • Biosimilar Program

    Effective July 1, 2020, MCC implemented a Biosimilar Program for you and your patients that includes the J Codes listed below:

    • J0885 Epoetin alfa, non-esrd
    • J1442 Inj filgrastim excl biosimil
    • J1745 Infliximab not biosimil 10mg
    • J2505 Injection, pegfilgrastim 6mg
    • J9035 Bevacizumab injection (excludes intraocular bevacizumab injections)
    • J9355 Inj trastuzumab excl biosimi
    • J9312, rituximab, 10 mg

     

    A biosimilar product is highly like, and has no clinically meaningful differences in safety, purity and potency (safety and effectiveness) from, an existing FDA-approved reference product. A manufacturer developing a proposed biosimilar demonstrates that its product is highly similar to the reference product by extensively analyzing (i.e., characterizing) the structure and function of both the reference product and the proposed biosimilar. A manufacturer must also demonstrate that its proposed biosimilar product has no clinically meaningful differences from the reference product in terms of safety, purity, and potency (safety and effectiveness).

    J Code utilization management medical necessity requests for reference products that have a biosimilar product will require a trial/failure of the respective biosimilar product. Patients with an existing authorization or who are currently on a reference product will not be required to try/fail a biosimilar product. Additional information on biosimilars may be accessed at the U.S. Food and Drug Administration Biosimilar website.