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.

Quantity Limit Criteria  

Pre-Authorization Criteria

• 2012 Pre-Authorization Criteria Dorado Select, Premier Preferred, Medicare en el Hogar Plus, PMC Max, Premier Preferred Platino, Elite Dorado, MediMax One, MediMax Plus. (Updated 10/2011)

 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.

MAPD y MA Plans

PDP Plans