The managed prescription drug coverage (MRxC) program includes coverage for specific drug therapy categories (i.e., migraine, onychomycosis, COX-II inhibitors, proton pump inhibitors, pain management, etc.) with set thresholds or limits. The MRxC program uses specific criteria as set forth by the Highmark Pharmacy and Therapeutics (P&T) Committee to assess the information provided to support requests for additional quantities.
To search for drugs and their prior authorization policy, select Pharmacy Policies - SEARCH on the left menu or at the top of the page.
When these limits are exceeded, the pharmacy receives a claim reject message that triggers a case evaluation. A clinical pharmacist consults with the prescribing physician to determine if the utilization of the medication is appropriate or if alternative treatment options should be implemented. Requests for Proton Pump or COX-II inhibitors can be initiated by calling our claims processor at: 1-800-753-2851.
Last updated on 10/31/2017