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Carefirst exchange formulary

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To view this form, check our Drug Forms. Prior authorization is required before you fill prescriptions for certain drugs. Your doctor must obtain prior authorization before they can be filled. Without prior authorization approval, your drugs may not be covered. Step therapy ensures you receive a lower-cost drug option as the first step in treating certain health conditions. When similar drugs are available, step therapy guides your doctor to prescribe the lower-cost option first.

You may then move up the cost levels until you find the drug that works best for you. Higher step drugs may require prior authorization by your doctor before they can be covered. Quantity limits are placed on selected drugs for safety, quality or utilization reasons. Limits may be placed on the amount of the drug covered per prescription or for a defined period of time.

If your doctor decides that a different quantity of medication is right for you, your doctor can request prior authorization for coverage. Some drugs may not be covered on your formulary, or may have quantity limits. There is an exception process if you need an excluded drug, or an additional quantity, to be covered for medical necessity reasons. Your provider can submit a request on your behalf by contacting Prescription drug benefits.

Drug Tiers The prescription drugs covered on the CareFirst formulary drug list are reviewed and approved by an independent national committee comprised of physicians, pharmacists and other healthcare professionals who make sure they are safe and clinically effective. Tier 1: Generic Drugs. Tier 2: Preferred Brand Drugs. Tier 3: Non-Preferred Brand Drugs. Tier 4: Preferred Specialty Drugs.

Tier 5: Non-Preferred Specialty Drugs. Comprehensive Medication Review. Pharmacy Advisor. Prescription Guidelines To ensure you are receiving the most appropriate medication for your condition s , certain medications have prescription guidelines. Prior Authorization. Step Therapy. Quantity Limits. Find the latest information to stay safe and healthy on our Coronavirus Resource Center. Search For Care. CareFirst has plans to meet the needs of all businesses—from small and locally owned to national companies.

Explore Our Plans. Have questions about health insurance? Explore our Insurance Basics page. A new patient-centric, virtual-first primary care practice. Compassionate care for over conditions through an easy-to-use app. CloseKnit's care teams offer preventive and urgent care, behavioral and mental health, chronic condition prevention, medication management and more.

Learn More. We're on a mission to make quality care affordable, easy to use and available to everyone in Maryland, Washington, D.

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WebWithin the formulary, prescription drugs are divided into tiers as described below. Depending on your plan, prescription drugs fall into one of four drug tiers which . WebA formulary is a list of covered prescription drugs. Our drug list is reviewed and approved by an independent national committee comprised of physicians, pharmacists and other . Drug search. Controlling drug costs is one of the major challenges of our healthcare system. With CareFirst’s prescription drug benefit, you can manage these expenses through a formulary system, which gives preference to the most effective, and cost-effective, medications. To check whether your drug (s) are covered, determine your out-of.