HIV/AIDS carve in to MCO benefit information 

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Prior Authorization for Antipsychotic Medications
For our updated (new) PA forms,
Please see the links below
 
For The Peer Review Program (Ages 0 to 17 years)
 
For Tier 2 and Non-Preferred Prior Authorizations (Ages 18 years and up) 
 
 

Information for Consumers

The Maryland Medicaid Pharmacy Program (MPP) Provides services for the following programs:

Medical Assistance

Receive complete pharmacy services.

HealthChoice

Mental Health FormularySubstance Use Disorder Medication Clinical Criteria Final,  All other drugs are provided by HealthChoice Managed Care Organizations (MCOs).

Family Planning

Receive only contraceptives and sexually transmitted infections treatment.

Medicare Part D

Fully dual eligible Medicare beneficiaries receive most drugs excluded from Medicare Coverage -- All other drugs are provided by Medicare Prescription Drug Programs (PDPs). Please note that beginning 01/01/2013, drug coverage for Benzodiazepines and Barbiturates for those patients that are both Medicaid and Medicare eligible,will be provided by Medicare Part D Prescription Drug Plans  and not the Maryland Medicaid Pharmacy Program. This change may cause patient co-payments to vary.

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