The managed prescription drug coverage (MRxC) program includes coverage for specific drug therapy categories (i.e., migraine, onychomycosis, 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.
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. The prescribing physicial will then be directed to complete the Prescription Drug Medication request form.