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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.

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 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.

For Covered Outpatient Medications

Prior authorization requests for covered outpatient medications is processed through Express Scripts, Inc. (ESI) the pharmacy benefits manager for Maryland Physicians Care. Call ESI directly at 800-753-2851 or fax the appropriate Prior Authorization Form to 877-251-5896.

For Specialty Medications

Prior authorization review for specialty medications is based on the pharmacy benefit used for the distribution of the medication. Therefore, refer to the MPC Specialty Medication List (PDF) to determine the appropriate process for specialty medication prior authorization requests.

For Oncology Medications

Prior Authorization for oncology medications within a treatment regimen will be processed by Eviti. Your office can sign up for training at www.welcometoeviti.com to learn how to access the web based system. If you have any additional questions, please call eviti, Inc., our oncology vendor, @ 1-888-678-0990 (toll free).

Request for authorization for oncology medications off-label use will be processed through Maryland Physicians Care.

For Hepatitis C Medications

Hepatitis C drug prior authorizations are processed by MPC's Pharmacy Department using the Maryland Department of Health (MDH) Hepatitis C clinical criterial. Fax the completed MDH Hepatitis C Prior Authorization Form with clinical information to 800-953-8856.

Non-Formulary Exception Process

To support routine non-Formulary pharmacy authorization decisions, MPC uses guidelines based on FDA-approved indications, evidence-based clinical literature, recognized off-label use supported by peer-reviewed clinical studies, and member’s benefit design, which are applied based on individual members.

The Non-Formulary Guideline is used to evaluate authorization requests for which there are not specific guidelines. A request may be authorized if the medications is deemed to be medically necessary for any of the following reasons:

  • Up to two (2) formulary drugs (when available) in the same theraputic category have been utilized for an adequate trial and have not been effective OR
  • Formulary drugs in the same therapeutic category are contra-indicated OR
  • There is no therapeutic alternative listed on the Formulary.

To request a non-formulary exception, call the prior authorization team at Express Scripts, Inc. at 1-800-753-2851.

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