Pharmacy

MedStar Family Choice District of Columbia offers a wide variety of prescription medications on its formulary. MedStar Family Choice DC also pays for many over-the-counter (OTC) medications.

MedStar Family Choice DC covers a 90-day supply of most chronic medications at retail pharmacies and through mail order. For more information on medications available for a 90-day supply and how to register MedStar Family Choice DC Enrollees for mail order pharmacy, click here.

FORMULARY INFORMATON

• MedStar Family Choice District of Columbia Formulary

• Recent Formulary Updates - The following is a list of formulary updates made at the most recent MedStar Family Choice DC Pharmacy & Therapeutic Committee meeting. This list of upcoming formulary changes may be available before the posted formulary document has been updated; to ensure you are viewing the most up to date information, please reference the formulary document as well as the most recent update link here: October and November 2024 (effective January 2025)

• Covered OTC Medication List

• Specialty Quantity Limit Drug List

MEDICATION PRIOR AUTHORIZATION INFORMATION AND FORMS

For those medications that require prior authorization or for non-formulary medication requests, please submit a request (see link below for the form) to MedStar Family Choice DC. Requests must include clinical documentation that supports the medical need for the specific medication. Physicians may call MedStar Family Choice DC at 855-798-4244, or fax requests to 202-243-6258.

• Prior Authorization and Step Therapy Table - a comprehensive listing of all medications requiring prior authorization and step therapy with criteria necessary for approval.  

• Opioid Prior Authorization Form

• Prior Authorization/Non-Formulary Medication Request Form (Non-opioid)

For Pharmacy requests, MedStar Family Choice DC must make a decision within 24-hours of receipt of the request. Please ensure that all pertinent clinical information is provided with the request to prevent any denial of service for lack of clinical information.

If a physician feels it medically necessary to prescribe a medication not on the formulary, the physician may submit this request to MedStar Family Choice DC for prior authorization. Such a request must include clinical documentation that supports the medical need for that specific medication. All non-formulary requests are reviewed by a Medical Director. MedStar Family Choice does not guarantee coverage of medications that are outside the guidelines set forth in the manual.

MEDICATIONS WITH EXTRA CLINICAL AND ORDERING REQUIREMENTS

• HIV Medications and Pre-Exposure Prophylaxis (PrEP) 

• Synagis

• Opioid Prior Authorization Requirements 

For the most up-to-date pharmaceutical recall information, please visit the U.S. Food and Drug Administration website at https://www.fda.gov/Drugs/DrugSafety/DrugRecalls/default.htm.