Pharmacy

MedStar Family Choice District of Columbia offers a wide variety of prescription medications on its formulary. MedStar Family Choice DC also pays for many over-the-counter (OTC) medications.

MedStar Family Choice DC covers a 90-day supply of most chronic medications at retail pharmacies and through mail order. For more information on medications available for a 90-day supply and how to register MedStar Family Choice DC Enrollees for mail order pharmacy, click here.

FORMULARY INFORMATON 

• MedStar Family Choice District of Columbia Formulary

• Recent Formulary Updates- The following is a list of formulary updates made at the most recent MFC-DC Pharmacy & Therapeutic Committee meeting. This list of upcoming formulary changes may be available before the posted formulary document has been updated; to ensure you are viewing the most up to date information, please reference the formulary document as well as the most recent update link below: 

• August 2023 (effective October 2023)

• Formulary Quick Reference

• Covered OTC Medication List

PRIOR AUTHORIZATION INFORMATION AND FORMS

For those medications that require prior authorization or for non-formulary medication requests, please submit a request (see link below for the form) to MedStar Family Choice-DC. Requests must include clinical documentation that supports the medical need for the specific medication. Physicians may call MedStar Family Choice-DC at 855-798-4244, or fax requests to 202-243-6258.

• Prior Authorization and Step Therapy Table - a comprehensive listing of all medications requiring prior authorization and step therapy with criteria necessary for approval.

• Hepatitis C Medication Prior Authorization Form (for non-formulary HCV medications only)

• Synagis Prior Authorization Form

• Opioid Prior Authorization Form

• Prior Authorization/Non-Formulary Medication Request Form (Non-opioid, Hep C, or Synagis)

MEDICATIONS WITH EXTRA CLINICAL AND ORDERING REQUIREMENTS 

• HIV Medications and Pre-Exposure Prophylaxis (PrEP) 

• Synagis 

• Opioid Prior Authorization Requirements

• Makena - FDA approval of Makena and all generic forms of 17-alpha hydroxyprogesterone caproate injection (17-OHP), was withdrawn on April 6, 2023.

  Please refer to the American College of Obstetricians and Gynecologists (ACOG) guidance regarding the use of progesterone for the prevention of preterm birth that can be found in ACOG Practice Bulletin No. 234, Prediction and Prevention of Spontaneous Preterm Birth, for additional information. 

For the most up-to-date pharmaceutical recall information, please visit the U.S. Food and Drug Administration website at https://www.fda.gov/Drugs/DrugSafety/DrugRecalls/default.htm.