As a reminder, effective January 1, 2022, there will be changes to the Mercy Care Advantage (MCA) Formulary. Some drugs that are covered this year will become non-formulary next year. Other drugs will require prior authorization, and some will have quantity limits. The Centers for Medicare and Medicaid Services (CMS) has approved the 2022 Mercy Care Advantage Formulary.
A written notification was recently sent to the Mercy Care Advantage members affected by a drug being removed from the formulary next year. The notice explains the change and includes the names of covered alternative drugs. It encourages them to discuss the change with their doctor. It explains their right to file a grievance if they disagree with this change and how to request a Part D coverage determination exception to ask for approval to continue coverage of their current drug. We will also be notifying prescribing providers treating Mercy Care Advantage members affected by this formulary change.
We are asking for your support to help minimize the impact this change will have to Mercy Care Advantage members. If you are treating Mercy Care Advantage patient(s) affected by the non-formulary drug changes, they may contact your office after they receive our notification about their affected drug. We ask that you review the 2022 formulary for the covered alternative drugs to determine if your patient(s) can be changed to a covered alternative drug before January 1, 2022. If you think a patient needs to continue taking their current drug, please submit a Part D coverage determination exception request to the health plan before January 1, 2022 for review.
If you feel a Part D coverage determination exception is required, please fax this request along with supporting documentation to our Pharmacy Department at 1-855-230-5544.
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