Mercy Care Advantage CY2022 Benefit and Formulary Changes effective 01/01/2022
Applicable to: Mercy Care Advantage
The Centers for Medicare and Medicaid Services (CMS) has approved the Mercy Care Advantage (MCA) benefit and formulary changes that will become effective January 1, 2022. As required by CMS, in late September Mercy Care Advantage mailed our current membership a copy of the Mercy Care Advantage 2022 Annual Notice of Change (ANOC) document and other important plan information. The ANOC explains the Mercy Care Advantage benefit changes that will become effective on January 1, 2022. Mercy Care Advantage has made positive enhancements to the supplemental benefits we’ll offer to our members next year. By October 15, 2021, Providers will be able to review the Mercy Care Advantage supplemental benefit changes by accessing the 2022 Annual Notice of Change (ANOC).
In addition, Mercy Care Advantage will have Part D Formulary and utilization management criteria changes that will apply to certain drugs effective January 1, 2022. We strongly encourage providers to review the 2022 Mercy Care Advantage Formulary in advance of the new year to identify if any Part D drugs your Mercy Care Advantage patients are currently taking this year will be impacted by a formulary in 2022. If a current drug will not be covered under the 2022 Mercy Care Advantage Formulary, providers should assist their patients in transitioning to a covered Part D drug or request a Part D drug Coverage Determination Exception prior to January 1, 2022 to help prevent medication treatment disruption.
Coverage Determination Exception requests related to the 2022 MCA formulary changes can be submitted starting in November 2021 for review. Providers can download, print and complete the Part D Coverage Determination Request form and fax it with supporting documentation (if applicable) to 1-855-230-5544. Providers can find more information about the Part D Coverage Determinations and Exceptions process on our website.
As always, 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 website.
