Part D - Pharmacy
- 2012 Drug Formulary
- Notice of Formulary Changes
- 2012 Provider and Pharmacy Directory
- Out-of-Network Coverage
- Reimbursement Policy
- Transition Policy
- Coverage Determinations
- Exceptions
- Appeals and Grievances
- Request for Redetermination
- Quality Assurance Policy
- CMS Appointment of Representation Form
- Medicare Prescription Drug Determination Request Form
2012 Drug Formulary
The formulary is a list of drugs selected by the PMC Pharmacy and Therapeutic Committee that includes prescription drug therapy, and is considered a necessary part of a quiality therapy program. Generally, PMC covers drugs included in our formulary , as long as they are medically necessary; the prescription is obtained from pharmacy within the PMC network, and complies with other regulations established by the plan.
Medicare Advantage with Prescription Drug Coverage:
PMC Max (HMO)
Medicare en el Hogar Plus (HMO SNP)
Elite Dorado (HMO)
Prescription Drugs Plans
MediMax One (PDP)
MediMax Plus (PDP)
MediMax Elite (PDP)
Group Plans
Platino Plans
Premier Preferred Platino (HMO SNP)
OTC Drug Formulary
Medicare en el Hogar Plus (HMO SNP)
Quantity Limit Criteria
Pre-Authorization Criteria
Step Therapy Criteria
- 2012 Step Therapy Criteria Dorado Select, Premier Preferred, Medicare en el Hogar Plus, PMC Max, Premier Preferred Platino. (Updated 10/2011)
- 2012 Step Therapy Criteria Elite Dorado, MediMax One, MediMax Plus. (Updated 10/2011)
If you would like to request an exception from PMC to our drug Formulary or tier exception, you will need to complete a Coverage Determination Request Form.
How to download documents
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