Mail order pharmacy services
Your patients don't have to leave their homes to get their medications. They can get their medications mailed to them. Or, if they prefer, they can get the medications mailed to their provider's office. They can start the mail-order process by completing a mail-order request form or signing up online.
They can call Mercy Care Member Services at 602-212-4983 or 1-833-711-0776 (TTY/TDD 711) to request a mail-order form. Or, download a mail-order service form here: English | Spanish
They can also register for mail order with CVS Caremark at www.caremark.com. Once they've registered, they can order refills, renew prescriptions and check their orders.
Learn more about member drug benefits, view formularies and formulary updates. Help your patients get the prescription drugs they need in an easy and cost effective way.
Formulary (covered medication list)
You now have the ability to use the new Formulary Search Tool to find out which medications are on the formulary drug lists. You can search by drug name or drug class. The search tool will show formulary status, generic alternatives and if there are any requirements, such as prior authorization, quantity limits or age limits. The formularies can change.
- Aimovig 140mg/ml Autoinjector (Prior Authorization Required)
- Aimovig 70mg/ml Autoinjector (Prior Authorization Required
- Anoro Ellipta 62.5-25mcg Inhaler (Prior Authorization Required)
- Cafergot Tablet 1-100mg (Brand Only)
- Enbrel 25mg/0.5ml Vial (Prior Authorization Required)
- Jentadueto XR 2.5-1000mg (Prior Authorization Required)
- Jentadueto XR 5-1000mg (Prior Authorization Required)
- Kazano 12.5-1000mg Tablet (Brand Only, Prior Authorization Required)
- Kazano 12.5-500mg Tablet (Brand Only, Prior Authorization Required)
- Nesina 12.5mg Tablet (Brand Only, Prior Authorization Required)
- Nesina 25mg Tablet (Brand Only, Prior Authorization Required)
- Nesina 6.25mg Tablet (Brand Only, Prior Authorization Required)
- Oseni 12.5-15mg Tablet (Brand Only, Prior Authorization Required)
- Oseni 12.5-30mg Tablet (Brand Only, Prior Authorization Required)
- Oseni 12.5-45mg Tablet (Brand Only, Prior Authorization Required)
- Oseni 25-15mg Tablet (Brand Only, Prior Authorization Required)
- Oseni 25-30mg Tablet (Brand Only, Prior Authorization Required)
- Oseni 25-45mg Tablet (Brand Only, Prior Authorization Required)
- Perseris ER 120mg Syringe (Age Limit)
- Perseris ER 90mg Syringe (Age Limit)
- Proglycem 50mg/ml (Brand Only)
- Ubrelvy 100mg Tablet (Prior Authorization Required)
- Ubrelvy 50mg Tablet (Prior Authorization Required)
- Ritalin LA 10mg Capsule (Brand Only)
- Ritalin LA 20mg Capsule (Brand Only)
- Ritalin LA 30mg Capsule (Brand Only)
- Ritalin LA 40mg Capsule (Brand Only)
- Avsola 100mg Vial (Prior Authorization Required)
- Ivermectin 3mg Tablet (Quantity Limit)
- Aptensio XR 10mg Capsule
- Aptensio XR 15mg Capsule
- Aptensio XR 20mg Capsule
- Aptensio XR 30mg Capsule
- Aptensio XR 40mg Capsule
- Aptensio XR 50mg Capsule
- Aptensio XR 60mg Capsule
- Bevespi Aerosphere Inhaler 9-4.8mcg/act
- Depo-Provera 400mg/ml Vial
- Gvoke Hypopen 1mg/0.2ml
- Humulin N 100Unit/ml Kwikpen
- Humalog Mix 50-50 Kwikpen
- Methylphenidate LA 60mg Capsule
- Norethindrone 5mg Tablet
- Renflexis 100mg Vial
- Vyvanse 10mg Chewable Tablet
- Vyvanse 20mg Chewable Tablet
- Vyvanse 30mg Chewable Tablet
- Vyvanse 40mg Chewable Tablet
- Vyvanse 50mg Chewable Tablet
- Vyvanse 60mg Chewable Tablet
- Endari Powder 5mg (Prior Authorization Required)
- Hydrochlorothiazide tablet 12.5mg
- Insulin Aspart 100u/ml Cartridge
- Insulin Aspart 100u/ml Pen
- Insulin Aspart 100u/ml Vial
- Insulin Aspart Mix 70/30 Pen
- Insulin Aspart Mix 70/30 Vial
- Insulin Lispro 100u/ml Pen
- Insulin Lispro 100u/ml Vial
- Insulin Lispro Jr 100u/ml Pen
- Insulin Lispro Jr 100u/ml Vial
- Insulin Lispro Mix 75/25 Pen
- Insulin Lispro Mix 75/25 Vial
- Nayzilam (Prior Authorization Required, Quantity Level Limit)
- Caffeine Powder Citrated
- Humalog 100u/ml Kwikpen
- Humalog 100u/ml Vial
- Humalog Jr 100u/ml Kwikpen
- Ibrance 100mg Cap
- Ibrance 125mg Cap
- Ibrance 75mg Cap
- Lidocaine- Hydrocortisone Cream Rectal 3-0.5%
- Methoxsalen Cap 10mg
- Novolog 100u/ml Flexpen
- Novolog 100u/ml Penfill
- Novolog 100u/ml Vial
- Novolog Mix 70/30 Vial
- BP Foam Aer 9.8%
- Renflexis 100 Mg Vial (Prior Authorization Required)
- Tretinoin Cream 0.025%
- Tretinoin Cream 0.05%
- Tretinoin Cream 0.1%
- Tretinoin Gel 0.01%
- Tretinoin Gel 0.025%
- Sumatriptan Succinate Inj 6 Mg/0.5ml (Quantity Level Limit)
- Sumatriptan Succinate Solution Auto-Injector 4 Mg/0.5ml (Quantity Level Limit)
- Sumatriptan Succinate Solution Auto-Injector 6 Mg/0.5ml (Quantity Level Limit)
- Sumatriptan Succinate Solution Cartridge 4 Mg/0.5ml (Quantity Level Limit)
- Sumatriptan Succinate Solution Cartridge 6 Mg/0.5ml (Quantity Level Limit)
Pharmacy prior authorization guidelines
Some prescriptions require prior authorization from Mercy Care before they can be filled. Requests for medications requiring Prior Authorization (PA) will be reviewed based on the PA Guidelines/Criteria for that medication.
Medications that do not have a specific PA guideline will follow the Non-Formulary Medication Guideline. Additional information may be required on a case-by-case basis to allow for adequate review.
- Mercy Care Prior Authorization Guidelines
- Botulinum Toxins
- Colony Stimulating Factors
- Cytokine and CAM Antagonists
- Growth Hormone
- Hepatitis C
- Hereditary Angioedema
- Immune Globulins
- Injectable Osteoporosis Agents
- Multiple Sclerosis
- Opioids 5-Day Supply Limit
- Smoking Cessation
- Step Therapy Prior Authorization Guidelines
Pharmacy prior authorization forms
Mercy Care requires prior authorization for certain drugs on the Preferred Drug List and for all non-formulary drug requests.
You may now request prior authorization by calling , or you may print the required prior authorization form below and fax it along with supporting clinical notes to 1-800-854-7614.
If the drug you are requesting is not listed, please use the Non-Formulary PA request form. Most drugs will require use of the Non-Formulary PA form. If you would like a prior authorization request form faxed to you, please contact the Mercy Care Pharmacy Prior Authorization team at .
These are fax forms for drugs in our prior authorization program. Select the drug name to download the prior authorization request form.
- Universal Pharmacy Prior Authorization Request Form
- Botulinum Toxins (Botox, Dysport, Mybloc, Xeomin)
- Calcitonin Gene-Related Peptide Receptor Antagonists (Ajovy, Emgality, Aimovig, Nurtec, Ubrelvy, Vyepti)
- Clozapine Under 18 Years Old
- Colony Stimulating Factors (ex: Neupogen, Fulphila, Udencya)
- Concomitant Antidepressant
- Concomitant Antipsychotic
- Cystic Fibrosis (Bethkis, Kitabis, Cayston, Kalydeco, Pulmozyme, etc)
- Cytokine and CAM Antagonists (ex: Enbrel, Humira)
- Dalfampridine (Ampyra)
- Erythropoiesis Stimulating Agents (Aranesp, Epogen, Procrit, Retacrit, etc)
- Gonadotropin Releasing Hormone Analogs (Lupron, Orilissa, Supprelin LA, etc)
- Growth Hormone(Genotropin, Norditropin)
- Hemophilia (Factor VIIa, Factor VIII, Factor IX, Novoseven, Hemlibra, etc)
- Hepatitis C
- Hyaluronic Acid Derivatives (Gel-One, Visco-3)
- Idiopathic Pulmonary Fibrosis Agents (Esbriet, Ofev)
- Injectable Osteoporosis (Tymlos, Evenity, Forteo, Prolia, zoledronic acid)
- Interleukin-5 Antagonists (Cinqair, Fasenra, Nucala)
- Interferons (Actimmune, Intron-A, Pegasys, etc)
- Janus Associated Kinase Inhibitors (Inrebic, Jakafi)
- Long Acting Antipsychotic Injectables Under 18 Years Old
- Monoamine Depletors (Austedo, Ingrezza, tetrabenazine)
- Multiple Sclerosis Agents (Avonex, Betaseron, Copaxone, Gilenya, Glatopa 40mg, Rebif/Rebidose, etc)
- Pulmonary Arterial Hypertension Agents (Tracleer, Letairis, Adcirca, Sildenafil, Revatio susp)
- Pyrimethamine (Daraprim)
- Somatostatin Analogs and Somavert (Sandostatin, Sandostatin LAR Depot, Signifor, Signifor LAR, Somatuline Depot, Octreotide)
- Thrombopoiesis Stimulating Products (Promacta, Nplate, Tavalisse)
Electronic Prior Authorization (ePA)
We are committed to making sure our providers receive the best possible information, and the latest technology and tools available.
We have partnered with CoverMyMeds® and SureScripts to provide you a new way to request a pharmacy prior authorization through the implementation of Electronic Prior Authorization (ePA) program.
With Electronic Prior Authorization (ePA), you can look forward to:
- Time saving
- Decreasing paperwork, phone calls and faxes for requests for prior authorization
- Quicker Determinations
- Reduces average wait times, resolution often within minutes
- Accommodating & Secure
- HIPAA compliant via electronically submitted requests Getting started is easy. Choose ways to enroll:
- No cost required! Let us help get you started!
- Visit the CoverMyMeds® website
- Call CoverMyMeds® toll-free at 866-452-5017
- Visit the SureScripts website
- Call SureScripts toll-free at 866-797-3239
- Time saving
Over-the-counter product list
How to order specialty drugs for patients CVS Caremark Specialty Pharmacy offers medications that are not often available at local pharmacies for a variety of conditions, such as cancer, hemophilia, immune deficiency, multiple sclerosis and rheumatoid arthritis.
Specialty medications require prior authorization before they can be filled and delivered. These medications can be delivered to the provider’s office, member’s home or other location as requested.
For providers who prefer to purchase the specialty drug and bill through the member’s Medical Insurance:
- Call to initiate prior authorization for the requested specialty medication.
For providers who prefer to bill through the member’s Pharmacy Insurance directly:
Adding a new drug to the formulary
You work with patients every day, and there may be times when you believe we should add a drug to the formulary. If you want to ask for a change to Mercy Care’s Preferred Drug List (PDL), include the following information in your request:
- Basic product information
- Indications for use
- Therapeutic advantage
- Which drug(s) it would replace in the current PDL
- Any supporting literature from medical journals
The requesting physician may be invited to attend the Pharmacy and Therapeutics Committee meeting to support the PDL addition request and answer questions.
Requests should be sent to: Aetna Corporate Pharmacy Director 4500 E. Cotton Center Blvd. Phoenix, AZ 85040
Controlled Substance Prescription Monitoring Program (CSPMP)
The Controlled Substance Prescription Monitoring Program (CSPMP) is a program developed to promote public health and welfare by detecting diversion, abuse, and misuse of prescription medications classified as controlled substances. Every physician who possesses DEA registration is required to also possess a CSPMP registration.
- Step 1: Register
- Register for CSPMP. Click on ‘Register now’ and fill out the ‘New Registration’ information.
- Step 2: Verify
- After you submit the registration form, you will receive a verification email with your CSPMP ID number and verification code.
- Follow the email link to verify your email address.
- Step 3: Login
- Once you login, you will then be able to complete your registration profile with your CSPMP ID and DEA number.
Fill out the ‘Registration Details’ and certify that the application is complete and accurate, then ‘Print Certificate’.