The Medical Assistance Formulary: What You Need to Know

The Medical Assistance Formulary is a list of drugs that are covered under the medical assistance program. This formulary is also known as the Medicaid Drug Formulary.

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Introduction

The Medical Assistance Formulary is a list of drugs that are approved for use by the Minnesota Department of Human Services (DHS). This formulary is utilized by DHS-contracted health plans when making coverage determinations for medical assistance recipients.

The formulary is updated quarterly, and drugs may be added, deleted or placed in a different coverage category at any time. In general, newly released drugs or those that represent a significant therapeutic advance are reviewed for possible placement on the formulary within six months of release.

Of the more than 14,000 unique drug products available on the market, only about 3,000 are currently included on the Medical Assistance Formulary.

What is the Medical Assistance Formulary?

The Medical Assistance Formulary, also known as the drugs.com Formulary, is a list of prescription medications that are approved for coverage by Medical Assistance. The Formulary is divided into two parts: Part A and Part B. Part A covers medications that are considered to be medically necessary, while Part B covers medications that are considered to be non-preferred or lower cost alternatives. The Formulary is updated on a regular basis and new medications are added as they become available.

The Medical Assistance Formulary is designed to help patients and their prescribers choose the most appropriate and effective medication for their individual needs. It is important to note that not all medications included in the Formulary may be covered by Medical Assistance, and some may require prior authorization before they will be covered.

How can the Medical Assistance Formulary help you?

If you are a Wisconsin resident over the age of 60, disabled, or under the age of 18, you may be eligible for the Medical Assistance program. This program provides health insurance coverage for medical and long-term care services. One way that the Medical Assistance program helps to control costs is by using a formulary, or preferred list of drugs, to guide prescribing decisions.

The Medical Assistance Formulary is a list of drugs that are approved for use by Medical Assistance recipients. The Formulary is developed and reviewed by a team of physicians, pharmacists, and other healthcare professionals. The team reviews scientific studies, expert opinions, and other information to determine which drugs should be included on the Formulary.

The Formulary is divided into three tiers. Tier 1 includes generic drugs, which are available at the lowest co-payment. Tier 2 includes brand-name drugs that have been determined to be safe and effective alternatives to drugs in Tier 1. Tier 3 includes brand-name drugs that are generally not recommended as first-line treatments.

If you are prescribed a drug that is not on the Formulary, your doctor can request an exception from the Wisconsin Department of Health Services. If your doctor believes that a non-formulary drug is medically necessary for you, he or she will complete a Prior Authorization form and submit it to the Department for review. The Department will make a determination within five business days.

You can view the Medical Assistance Formulary on the Wisconsin Department of Health Services website: https://www.dhs.wisconsin.gov/forms/pdf/medassistance/dme339_18a_ma_formular y_020818_v2.pdf

What are some of the key benefits of the Medical Assistance Formulary?

The Medical Assistance Formulary is a list of drugs that are approved for use by recipients of medical assistance. The formulary is designed to promote the use of safe and effective drugs, while also providing recipients with the opportunity to receive the best possible care.

Some of the key benefits of the Medical Assistance Formulary include:

-The formulary promotes the use of safe and effective drugs.
-The formulary provides recipients with access to the best possible care.
-The formulary helps to ensure that medical assistance funds are used efficiently.

How can you access the Medical Assistance Formulary?

There are three ways to access the Medical Assistance Formulary:
1. The online formulary at https://medicaid.gov/medicaid/prescription-drugs/formulary/
2. The printed formulary that Medicaid providers receive every quarter
3. Contacting the Medicaid Pharmacy Help Desk

The online formulary is updated quarterly and provides detailed information on how to request prior authorization for a non-formulary drug, generic alternatives, quantity limits, and step Therapy requirements. The printed formulary is also updated quarterly; however, it does not provide the same level of detail as the online formulary.

The Medicaid Pharmacy Help Desk can be reached Monday through Friday from 8:00 am to 8:00 pm EST at 1-800-882-2583. Providers can also contact the Help Desk by email at [email protected]

What are some of the things to keep in mind when using the Medical Assistance Formulary?

The Medical Assistance Formulary is a tool that can be used to help you make informed decisions about your medical care. It is important to keep in mind that the Formulary is not a complete list of all available medications, but rather a guide to assist you in choosing the most appropriate medication for your individual needs.

There are a few things to keep in mind when using the Formulary:

1. You should always consult with your health care provider before starting any new medication.
2. The Formulary is a guide, and not all medications listed may be appropriate for your individual situation.
3. The Formulary is subject to change at any time. 4. You may need a prior authorization from Medical Assistance before beginning some of the medications listed on the Formulary.
5. If you have any questions about the Formulary or your individual situation, please contact your health care provider or pharmacist for more information.

How often is the Medical Assistance Formulary updated?

The Medical Assistance Formulary is a list of FDA-approved prescription drugs that are covered under the Minnesota Medical Assistance (MA) program. The formulary is updated at least every six months, and more often if necessary. The update schedule is available on the Medical Assistance website.

What happens if a medication you need is not on the Medical Assistance Formulary?

There are some cases where a non-preferred drug may be medically necessary for you. If your doctor believes that a non-preferred drug is medically necessary for you, they can ask PAAD for a Prior Authorization.

A Prior Authorization is when PAAD asks your doctor for more information about why the non-preferred drug is medically necessary for you. PAAD will also ask your doctor if there are any other preferred drugs that would work just as well or better for you.

If PAAD approves the Prior Authorization, we will then cover the cost of the non-preferred drug for you. If PAAD does not approve the request, your doctor can ask us to review our decision.

Where can you find more information about the Medical Assistance Formulary?

The Medical Assistance Formulary is a list of drugs that are approved for use by Medical Assistance recipients. The Formulary is developed and maintained by the Department of Health and Human Services (HHS), in consultation with the Centers for Medicare and Medicaid Services (CMS).

You can find more information about the Medical Assistance Formulary on the HHS website or on the CMS website.

Conclusion

In conclusion, the Medical Assistance Formulary is a list of drugs that are covered under the Medical Assistance program. This formulary is reviewed and updated on a regular basis, and changes may occur at any time. It is important to note that the formulary is subject to change, and that coverage for certain drugs may be limited or not available at all. In addition, the formulary may not include all of the drugs that are available to treat a particular condition.

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