If you are enrolled in Medicaid, you must renew once a year or you will lose your coverage.

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Approved Drug Benefits

Maryland Physicians Care has a wide selection of approved drugs. 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.

Eviti Transition for Select Medications

Effective June 1, 2023, MPC will be terminating our autoimmune pilot. Providers will need to continue the current process of submitting prior authorization requests to Eviti for the medications listed below until the transition occurs on June 1, 2023. Starting on June 1, 2023, requests for the medications listed below must be submitted to our PBM, Express Scripts (ESI), for review and processing under the pharmacy benefit or to MPC for review and processing under the medical benefit.

For medications reviewed under the pharmacy benefit, providers must submit their prior authorization requests to ESI via e-PA system, fax at 1-877-251-5896 or may call directly into the ESI PA system at 1-800-753-2851 to initiate a prior authorization review.

Pharmacy Benefit Medications:

Ilaris (canakinumab)
Acthar Gel
Simponi Subq
Benlysta Subq
Stelara IV/Subq
Orencia Subq
Skyrizi IV/Subq
Actemra Subq

For medications reviewed under the medical benefit, providers must submit their prior authorization requests to MPC via fax at 1-800-953-8856 and may call MPC with any questions at 1-800-953-8854.

Medical Benefit Medications:

Orencia IV
Benlysta IV
Actemra IV
Simponi Aria IV

This update is only for the autoimmune pilot with Eviti and does not impact the MPC partnership with the Eviti Oncology platform. Please continue to send oncology related prior authorizations to Eviti via the online submission portal: Eviti Oncology PA Requests. If you have any questions regarding the termination of this pilot, please reach out to our provider relations phone number at 1-800-953-8854.

Step Therapy Requirements

Medications that require Step Therapy (ST) require trial and failure of preferred formulary agents prior to their authorization. If the prerequisite medications have been filled within the specified time frame, the prescription will automatically process at the pharmacy. Prior Authorization will be required for prescriptions that do not process automatically at the pharmacy. Click on the Step Therapy Requirements Guide (PDF) to learn more.

HIV Carve-in Benefit Information

As of January 1, 2020, all HIV medications were carved in as a pharmacy benefit from Maryland Medicaid to be managed by Medicaid recipients’ individual Managed Care Organization (MCO).

For additional information on HIV medications and prior authorization forms, click here.

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