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 Welcome to the Maryland HealthChoice Jai Medical Systems formulary guide on Formulary Navigator™

Effective January 1, 2020, antiretrovirals for the treatment of HIV (AHFS 8:18:08) will be carved into the HealthChoice MCO benefit from the FFS program.

Prescribers:  Please consult the member’s MCO for coverage information and to determine the appropriate action by June 2020 to prevent treatment disruption.

Pharmacists:  Please utilize the appropriate MCO billing information when submitting claims for this medication class.

Member page:  http://www.jaimedicalsystems.com/providers/pharmacy/

Formulary listing:  https://s27543.pcdn.co/wp-content/uploads/2019/04/2019-Jai-Medical-Systems-Formulary.pdf

Prior Authorization:  https://s27543.pcdn.co/wp-content/uploads/2019/12/Prior-Authorization-Guidelines-2019.pdf

Requests for high dose or long acting opioids require an attestation form that can be found at: http://www.jaimedicalsystems.com/providers/pharmacy/

Prior Authorization Request Forms for Hepatitis C treatment, as well as the most recent criteria, can be found at: http://www.jaimedicalsystems.com/providers/pharmacy/


You may search the Formulary in several ways: 

• Use the alphabetical list to search by the first letter of your medication.

• Search by typing part of the generic (chemical) and brand (trade) names.

• Search by selecting the therapeutic class of the medication you are looking for.

PLEASE NOTE: Because prescription drug programs vary by group, the inclusion of a drug in this formulary does not imply coverage. This formulary is subject to change throughout the year and plan exclusions may override this list. Benefit designs may vary with respect to drug coverage, quantity limits, step therapy, days supply and prior authorization. Please call the number listed on your member ID card if you have questions about your specific prescription drug benefits. Please discuss any questions or concerns about your drug therapy with your physician or pharmacist.

Alphabetical Search Skip to Brand & Generic Search

Brand & Generic Name Search


Therapeutic Class Search Skip to Footer

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The Maryland Department of Health Office of Pharmacy Services provides an online listing of formulary products paid fee-for-service through the pharmacy program.  Products are coded based on coverage and include additional resources to facilitate coverage of products.

Formulary Id: 00000027
Formulary Effective Date: 02/01/2020
CMS Approval Date:
CMS Version:

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