The following formulary reference guide lists commonly prescribed medications by drug class and by copayment level of Generic, Preferred and Non-Preferred. This reference guide is not all-inclusive, nor does it guarantee coverage. Changes to the formulary medication list can occur at any time during the plan year.
Printable Formulary Reference Guide (Formulary Trifold)
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FirstCarolinaCare Insurance Company (FCC) encourages members to use generic and preferred drugs to lower out-of-pocket costs.
The use of non-preferred medications will result in higher member out-of-pocket costs. members are encouraged to bring the formulary reference guide to provider visits so they can discuss the medication choices available to them.
FCC uses certain tools to help promote the use of safe and cost-effective medications and to reduce the potential for abuse or misuse of medications.
These restrictions include:
| Age: |
Coverage of certain medications may be restricted based on member's age. |
| Gender: |
Coverage of certain medications may be restricted based on member's gender. |
| Prior Authorization (PA): |
Coverage may require a PA to ensure certain medications meet medical necessity guidelines. Your physician will need to submit a PA form to MedImpact for review before the prescription can be filled. |
| Quantity Limit: |
Coverage of certain medications may be limited to specific quantities per prescription and/or time period. |
| Step Therapy: |
Coverage of certain medications may depend on previous use of another drug. |
For more information about FCC's complete formulary, visit MedImpact online at mp.medimpact.com or call (800) 788-2949.
