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In the Spotlight

APRIL 1, 2020: THE U.S. FOOD AND DRUG ADMINISTRATION (FDA) ORDERS ALL PRESCRIPTIONS AND OVER-THE-COUNTER (OTC) RANTIDINE PRODUCTS BE WITHDRAWN FROM THE MARKET:  The FDA has requested that manufacturers withdraw (remove) all prescription and OTC ranitidine products from the market (brand name is Zantac®).  Patients taking prescription products should contact their prescriber for an alternative prescription.  Patients using OTC versions will need to switch to a different product if continued treatment is needed (speak with your pharmacist about available options).  

For additional information visit the FDA HERE.


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90 Day Supply Options

Choice90 - external link, click on Choice90 graphic

MedImpact Direct Mail Order - external link


Formulary Guide



Pharmacy Benefit Manager Portal


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.


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 or pre-approval of a medication with other coverage rules, 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

Criteria, Step Therapy and Quantity Coverage Rules Effective July 1, 2020 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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