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In the Spotlight

August 2018 - Recall Notice: August Update - Valsartan Product Recall with Impacted Drug List adobe pdf

View Spotlight Archives

 

90 Day Supply Options

Choice90 - external link, click on Choice90 graphic

MedImpact Direct Mail Order - external link

 

Formulary Guide

COMPREHENSIVE PREFERRED FORMULARY WITH COVERAGE RULES effective Ocotber 1, 2019 adobe pdf

 

Pharmacy Benefit Manager Portal

MedImpact

MedImpact administers the prescription drug benefits for members.

For questions regarding your prescription drug benefits, please conact MedImpact toll-free at
(800) 788-2949 or visit their member web site.


Forms

Prescription Reimbursement Forms
For members to request reimbursement when they have paid for a prescription (where it wasn’t put through their insurance):
Pharmacy Reimbursement Claim Form adobe pdf

Medication Request Forms
Our pharmacy benefit manager, MedImpact Healthcare Systems, handles our prior authorizations. To request prior authorization, pre-approval of a medication with coverage rules or coverage of a Non-Formulary medication, your physician or prescribing practitioner can use the Standard Medication Request Form adobe pdf. Forms can be faxed to MedImpact at: 858-790-7100.
Standard Medication Request Form adobe pdf

 

Prior Authorizations or Step Therapy Requirements

Comprehensive Formulary List- including Criteria, Step-Therapy and Quantity Coverage Rules Effective October 1, 2019 adobe pdf

Prior Authorization Information

Step Therapy Information

 

Consumer Resources*

Generic Drugs from FDA Information about Generic Drugs from the Food and Drug Administration

*The above consumer links are posted as a resource for our members in making wise prescription drug choices. The web sites are not affiliated with FirstCarolinaCare Insurance Company.

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