Prescription Drugs with Additional Requirements
For certain prescription drugs, MVP Health Care has additional requirements for coverage or limits on our coverage. These requirements and limits ensure that our members use these drugs in the most effective way and help us control drug plan costs. A team of doctors and pharmacists developed these requirements and limits for our health plans to help us provide quality coverage to our members.
Why are certain drugs not covered?
Medicare rules do not allow Medicare Advantage plans to cover certain drugs, including drugs purchased outside of the United States, vitamins and mineral products, medications for cough or cold, drugs used “off-label,” or drugs used to treat erectile dysfunction or for cosmetic purposes.
For safety reasons and/or cost savings, certain drugs have limits on the amount that will be covered.
For safety reasons and/or cost savings, certain drugs need approval from MVP before they can be filled.
For safety reasons and/or cost savings, in some cases MVP requires you to first try one drug to treat your medical condition before we will cover another drug for the condition.
Coverage determinations provide a way for you to ask MVP for an exception to established policies about prescription drugs. Learn more about coverage determinations.