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Pharmacy Coverage FAQ

Health plans administered by MVP Select Care that have prescription drug coverage may have a "drug formulary" in place. The drug formulary is an approved list of medications – those proven safe, effective and in the best interests of the plan participants. Here are answers to some of the questions you may have about this program.


What drugs does MVP designate as covered in the formulary?
MVP's approved list of medications includes thousands of drugs, both generic and name-brand. In the cases where we do not cover a certain drug, we usually cover an alternative drug. To find a specific drug on this list, use our RX Search.


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How does MVP decide which drugs to designate as covered?
Decisions on which drugs are approved for coverage on the formulary list are made exclusively by the MVP Pharmacy and Therapeutics Committee. This is comprised of primary care and specialty physicians, pharmacists and other health care professionals. After a detailed review, the committee selects drugs which are proven safe, effective, and offer advantages over similar drugs for our plan participants. The formulary list is updated several times each year during committee meetings.


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What about new drugs – does MVP cover them?
MVP wants to ensure that plan participants have access to the latest advances in medicine. Every month, new prescription drugs are reviewed for coverage. Newly-introduced drugs will not be selected as covered until the MVP Pharmacy and Therapeutics Committee has reviewed them. If the committee determines that a new drug has a significant advantage over existing drugs the new drug will be covered. If a drug is no longer covered, the plan participant and prescribing physician will be notified of the change before it occurs.


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What if my doctor says I need a drug that MVP has selected as not covered?
MVP places great confidence in the clinical decisions of participating physicians and recognizes that there are instances where a drug listed as not covered may be required. In such cases, the prescribing physician can submit the medical reason to MVP to gain an approval for the plan participant.



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Are there any drugs that require prior approval before they are covered?
Yes, a few drugs require MVP prior approval to be covered. Specific written policies for these drugs are available by contacting our Customer Care Center via e-mail or toll-free at 1-800-229-5851.


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Note: Not all employer health plans administered by MVP include the MVP Prescription Drug Formulary. Call MVP if you are unsure about your plan, or if you have any questions.