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The Prior Authorization Process

The fax number for Express Scripts, the PBM for Maryland Physicians Care Pharmacy Prior Authorization (PA) Unit is 877-251-5896. You may call Express Scripts directly at 800-753-2851.

Some prior authorizations for specialty drugs and Hepatitis C will be sent to an alternate fax number, 800-953-8856.

Please reference our complete Pharmacy information and forms by clicking on the Prior Authorization Request Forms link in the left column.

Approved Drug Benefits

Maryland Physicians Care has a wide selection of approved drugs for you to choose from. The approved drug list includes generic prescription drugs and some brand-name drugs. Please consider a drug from the generic prescription drug list if it meets your patient’s medical needs.

You now have the ability to use the new Formulary Search Tool to find out which medications are on the formulary drug lists. You can search by drug name or drug class. The search tool will show formulary status and if a generic alternative is available. The formularies can change.

Some prescription drugs require prior authorization from Maryland Physicians Care before a pharmacy can fill the prescription. You can complete the applicable Prior Authorization Form and fax it to Maryland Physicians Care Pharmacy Prior Authorization (PA) Unit at 1-866-207-7231, or call the Maryland Physicians Care Pharmacy PA team at 1-800-953-8854. If a drug that is not on this list is needed in an emergency, a limited supply will be given. You can call Maryland Physicians Care 24 hours a day at 1-800-953-8854.

The step therapy (ST) program requires certain first-line drugs, generic drugs or other formulary drugs to be prescribed prior to approval of specific second-line drugs. Please refer to the Step Therapy/Prior Authorization Requirements for more detailed information.

  • Prior Authorization Guidelines (UNDER REVIEW AUG. 2018)
  • Prior Authorization Detail
  • Step Therapy Requirements (PDF) (UNDER REVIEW AUG. 2018)

Specialty medications are medications that not often available at local pharmacies for a variety of conditions, such as cancer, hemophilia, immune deficiency, multiple sclerosis and rheumatoid arthritis. Specialty medications require prior authorization before they can be filled and delivered. You can find the applicable prior authorization form on our Prior Authorization Request Form page. Specialty medications can be delivered to your office, member’s home or other location as requested.

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