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

On November, 15, 2021, MPC transitioned the review of select medications prescribed for the treatment of autoimmune disease to our vendor Eviti. Effective June 1, 2022, MPC will be transitioning the review of additional medications prescribed for the treatment of autoimmune disease to our vendor Eviti. Eviti will process prior authorization requests prescribed for the autoimmune medications listed below:

Humira (adalimumab)
Ilaris (canakinumab)
Otezla (apremilast)
Taltz (ixekizumab)
Enbrel (etanercept)
Kevzara (sarilumab)
Simponi (golimumab)
Simponi Aria (golimumab)
Xeljanz (tofacitinib)
Xeljanz XR (tofacitinib)
Benlysta (belimumab)
IV/Subq
Orencia (abatacept)
IV/Subq
Stelara (ustekinumab)
IV/Subq
Fasenra (benralizumab)*
Nucala (mepolizumab)*
Actemra (tocilizumab)*
IV/Subq
Cimzia (certolizumab)*
Cosentyx (secukinumab)*
Kineret (anakinra)*
Rinvoq (upadacitinib)*
Skyrizi (Risankizumab-rzaa)*
Tremfya (guselkumab)*
Acthar Gel (corticotropin)*

* New medications transitioning on 06/01/2022 to Eviti for review

Prior authorization requests will be submitted via their web-based platform Eviti Connect® for Autoimmune Diseases. Eviti provides support for registration to their web portal and assistance with entering prior authorization requests into the platform. Support services for Eviti can be reached at clientsupport@nanthealth.com or 888-482-8057 option #2.

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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Attention: Similac Powdered Formula Recall

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