Welcome to the Maryland HealthChoice Jai Medical Systems formulary guide on Formulary Navigator™
Member page: http://www.jaimedicalsystems.com/providers/pharmacy/
Formulary listing: http://www.jaimedicalsystems.com/wp-content/uploads/2017/04/Jai-Medical-Systems-Formulary-2017.pdf
Prior Authorization: http://www.jaimedicalsystems.com/wp-content/uploads/2017/11/Prior-Authorization-Guidelines.pdf
Prior Authorization form: http://www.jaimedicalsystems.com/wp-content/uploads/2017/08/Prescription-Prior-Authorization-Form-Updated.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.