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MDA Health Plan Prescription Drug Information

All MDA Health Plan options include prescription drug benefits. The plans have three tiers, meaning there are three levels of co-pays. Additionally, step therapy is required for certain drugs. If you already have been through step therapy under a previous plan, documentation to that effect can be submitted to waive the requirement. Step therapy means that the efficacy of a series of less-costly drugs must be tried before the more expensive brand-name drugs may be approved as a benefit.

To aid in the transition to the MDA Health Plan, Priority Health will approve one 30-day transition fill for drugs you are currently taking that require step therapy. During this 30-dayperiod, you must provide Priority Health with evidence that you have previously completed step therapy requirements for the drug in question.

If prescriptions for the less-costly drugs were filled at the pharmacy you are using to fill the more-costly drug prescription, the pharmacist can contact Priority Health and provide the information about the drugs previously tried and the dates they were tried. Priority Health can then authorize dispensing the prescribed drug.

If you have tried the series of step-therapy drugs, but have had them filled at different pharmacies, please ask your doctor to contact Priority Health and advise them of the drugs that were tried and the dates they were prescribed.
Below I a link to a prior authorization form that your physician can complete and submit to show which drugs have been tried and to obtain approval for drugs that require step therapy. This form does not provide information on the specific drugs that are required to be tried in any step therapy process.

Prescription drug prior authorization form

Prescription Drug Links

Complete Approved Drug Formulary: For MDA Health Plan members
Commonly Prescribed Approved Drug List: Print and take with you to appointments.
Prescription Drug Prior Authorization From: For step-therapy drugs
Approved HSA Preventative Drug List: Paid prior to deductible for high-deductible health plan subscribers (Plan 6 as of 1-1-17)

Plan Documents

Additional details about the prescription drug program are found in the Summary Plan Descriptions below.  Adobe Acrobat Reader is required to access these documents. You may access a free download of Acrobat Reader by clicking here.

PPO Plans

Summary Plan Description for Plans 1-4, 8, 10
Schedule of Medical Benefits

High-deductible Health Plans (HSA)

Summary Plan Description for Plans 5, 6, 9
Schedule of Medical Benefits

Exclusive Provider Organization (EPO)

Summary Plan Description for Plan 7
Schedule of Medical Benefits

Want Vision Insurance?

MDA Insurance offers your choice of insured vision plans on a stand-alone basis. Plans are billed quarterly on an individual basis. For information on vision insurance plans and rates, please click here

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