The managed prescription drug coverage (MRxC) program includes coverage for specific drug therapy categories (i.e., migraine, onychomycosis, COX-II inhibitors, proton pump inhibitors, pain management, etc.) with set thresholds or limits. The MRxC program uses specific criteria as set forth by the Highmark Pharmacy and Therapeutics (P&T) Committee to assess the information provided to support requests for additional quantities.
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When these limits are exceeded, the pharmacy receives a claim reject message that triggers a case evaluation. A clinical pharmacist consults with the prescribing physician to determine if the utilization of the medication is appropriate or if alternative treatment options should be implemented.
Last updated on 5/24/2019