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. View the full list of medications with quantity limits for 2020.
For safety reasons and/or cost savings, certain drugs need approval from MVP before they can be filled. View the full list of medications that require prior authorizations for 2020.
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. View the full list of medications that require step therapy for 2020.
Coverage determinations provide a way for you to ask MVP for an exception to established policies about prescription drugs. Learn more about coverage determinations.