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-day period, 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 Links
Complete Approved Drug Formulary: For MDA Health Plan members
Prescription Drug Prior Authorization Form: For step-therapy drugs
Drug Authorization Forms List: Use the right form for your Priority Health plan