- Health & Human Services
- IMCare Division
- Providers & Partners
- Pharmacy & Formularies
Pharmacy & Formularies
Itasca Medical Care (IMCare) will maintain a formulary for products offered to its membership that is based on sound clinical evidence. The formulary will be reviewed and updated annually by the Pharmacy and Therapeutics Subcommittee.
- If your member is on our IMCare Classic (HMO SNP) plan. IMCare has an online search feature to see if specific Medicare Part D drugs are covered by IMCare Classic (HMO SNP).
IMCare will collaborate with its delegated Pharmacy Benefit Management (PBM) vendor on the development of the formulary and management procedures. IMCare contracts with Caremark to manage and pay pharmacy claims.
- If your member is on our IMCare Classic (HMO SNP) plan. You can use our online search feature to see if a specific pharmacy providers our in the IMCare Classic (HMO SNP) network.
IMCare will maintain a policy that outlines how to use pharmaceutical management procedures including quantities, generics, therapeutic interchange, and step-therapy protocols, prior authorization, and exceptions to the formulary. The policy will be reviewed and updated annually and as needed, in cooperation with Caremark and includes the participation of specialists to evaluate each class of pharmaceuticals.
IMCare will annually and as needed communicate pharmaceutical management procedures to providers via direct mail, website, and/or formulary booklet.
Click here for the recent MHCP Uniform PDL.
Pharmacy & Formularies Documents
- Medication Prior Authorization Form (PDF)
- Medication Override Request Form (PDF)
- 2023 IMCare MSHO List of Covered Drugs (Formulary) (PDF)
- 2023 Prior Authorization and Quantity Limits
- 2023 Step Therapy Criteria
- 2023 Medicaid List of Covered Drugs (PDF)
- IMCARE MSC + Wrap List (3387) Feb2023
- 2023 IMCare's 90-Day Supply Prescription Drug List
- Part D Transition Policy(2020)
- 2021 MSHO Provider and Pharmacy Directory (PDF)
- 2021 MSHO List of Covered Drugs (Formulary) (PDF)