Mercy Care Advantage (MCA) CY 2023 Benefit and Formulary Changes Effective January 1, 2023



Applicable to: Mercy Care Advantage

The Centers for Medicare and Medicaid Services (CMS) has renewed our Mercy Care Advantage (MCA) contract and approved the benefit and formulary changes that will become effective January 1, 2023. As required by CMS, in late September Mercy Care Advantage mailed our current membership a copy of the Mercy Care Advantage 2023 Annual Notice of Change (ANOC) document and other important plan information. The ANOC explains the MCA benefit changes becoming effective on January 1, 2023.  Mercy Care Advantage has made positive enhancements to the supplemental benefits that will be available to our members next year, such as adding coverage for dentures, providing an annual allowance for eyewear and contact lenses and increasing the monthly allowance for our over-the-counter (OTC) benefit which provides coverage for non-prescription drugs and personal health and wellness products. Medicare beneficiaries are able to make a Medicare plan change for a January 1, 2023 effective date during the Medicare Annual Election Period that occurs between October 15, 2022 through December 7, 2022.  

By October 15, 2022, providers can review the 2023 Mercy Care Advantage plan materials on our Mercy Care Advantage website. 

Please reference the 2023 Annual Notice of Change (ANOC) or 2023 Summary of Benefits to learn more about our benefit changes. 

Additionally, the Mercy Care Advantage Formulary and Part D drug utilization management criteria will have changes effective January 1, 2023. Some current brand name drugs will be removed, but the generic alternatives will be available. New drugs will be added to the formulary and some drugs will have prior authorization, step therapy, and/or quantity limits applied. MCA members affected by drugs being removed from the formulary will be notified in writing in November and their prescribing providers will also notified.  Providers are encouraged to review the 2023 Mercy Care Advantage Formulary that will be available on the Mercy Care Advantage website by October 15, 2022. 

Please assist your MCA patients affected by a formulary drug change next year by using one of the following available options:

1. Prescribe a Part D drug included in the 2023 Mercy Care Advantage Formulary; or
2. If your MCA patient needs to continue on their current drug treatment, request a Part D Coverage Determination Exception prior to January 1, 2023. In your request explain why your patient cannot take medications covered on the MCA formulary and include supporting clinical documentation. 

•  In November providers can begin submitting Part D Coverage Determination Exception requests for the 2023 Mercy Care formulary changes.
• Providers can download, print and complete the Part D Coverage Determination Request form and fax it with supporting clinical documentation to our Pharmacy Prior Authorization Department at 855-230-5544. 
• Providers can find more information about the Part D Coverage Determinations and Exceptions process on our website.  

In the meantime, don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care Advantage website.

Thanks for all you do!