MCS Farmaflex

Manage your medications wisely

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Manage your medications wisely

As an MCS member you will be able to know your medications history and view the details of your copayments. You just have to sign-up using our secure section (Mi MCS) to receive this exclusive benefit. Call our Customer Service Call Center to verify the access information, if needed.

Pharmacy Benefits

The pharmacy benefits is a main integral component of all health care services because it allows you to purchase your prescribed medications at participating pharmacies. And as usual, MCS goes the extra mile in your road to health, offering several initiatives and programs that complement your pharmacy benefit:

Over-the-Counter Drug Formulary

OTCs are approved over-the-counter drugs by the U.S. Food and Drug Administration. To find out if your coverage includes the OTC drug benefit, refer to your policy or certificate of benefits.

Formulary OTC - 2024

Medications by Mail Program

Your pharmacy benefit also allows you to obtain prescribed medications through mail. This program provides you a comfortable and cost-effective way to request a 90-day maintenance medication supply.

Conditions that require maintenance medications

High blood pressure

Cholesterol

Arrhythmias

Diabetes

Asthma

Thyroid

Advantages

Five steps to start

Ask your doctor for prescription for a maintenance of your medication for up to 90 days, plus refills.
Fill out the Medications using the Mail Application.
Include the prescriptions written by your doctor.
Include your copayment or coinsurance and/or your credit card information.
Include the documents mentioned in steps 2, 3, 4 above in an addressed and stamped envelope and put in the mail. Your medications will soon be on their way.

Frequently asked questions about our Medications by Mail Program.

Medications by Mail Application

Bioequivalent Medications

The Food and Drug Administration (FDA) regulates the production of all bioequivalent medications. Many of the companies that produce brand medications are the same that produce bioequivalent medications.

When you choose bioequivalent medications, you help to keep the costs of your pharmacy coverage at a lower level.

They are safe and effective!

They contain the same active ingredients as brand medications
Are identical in their presentation form (tablets, capsules), strength, dosage forms, and means of administration. Nonetheless, they can vary in form and color.

Specialty Medications Program

The Pharmaceutical Care Management Association (PCMA) defines specialty medications as medications that possess multiple of the following attributes:

High monthly cost
Not available at most chain or independent pharmacies. There are even drugs that have limited distribution.
- Limited Distribution: The manufacturing house only gives you access to the purchase of medicines at only a limited number of pharmacies.
Prescribed for a person with a chronic or complex illness, for example:
- rheumatoid arthritis
- multiple sclerosis
- crohn's disease
- ulcerative colitis
- cancer
- hepatitis C
- HIV
- psoriasis
- among others
Treats indications of rare diseases
- A rare disease is one that affects fewer than 200,000 Americans. There are approximately 7,000 rare diseases in the world.
It is an oral, injectable, inhalable or infusion medicine
Has unique storage or shipping requirements, such as refrigeration
Requires education, adherence, and additional patient support beyond traditional dispensing activities.

Most specialty drugs require a pre-authorization process (evaluation of your health plan) due to their high cost and usage specifications. Specialty medications may be covered by your Pharmacy Benefit or Medical Component, which will depend on the management that such medication requires:

Pharmacy Benefit	Medical Component
Oral medications Auto-injectable medications: Patient can self administered the medication	Intravenous medications Medications that must or may administered by a healthcare professional

Requirements

MCS requires pre-authorization for most specialty medications. This meaning that a minimal amount of information is required to evaluate a request for a specialty medication. For example:

Prescription that includes all the requirements according to the Puerto Rico Pharmacy Law.

It must also include the specific diagnosis for which the drug is prescribed. Ej. ICD10 - K51.0 Ulcerative (chronic) pancolitis without complications.

Additional information: History of previous treatments, laboratories, progress notes from your doctor, imaging tests, among others.

Biosimilars medications

Biosimilars are safe and effective drugs for the treatment of many chronic or complex diseases. These are biologic drugs approved by the Food and Drug Administration (FDA) that are comparable to another drug - the original drug. FDA approval is based on review of data, studies and tests, product quality, and monitoring of its safety and efficacy.

To better understand the concept of ‘biosimilars’, we will first need to understand the fundamental terms defined by the FDA.

Biological Product- Reference Drug	Biosimilars
They can be made with sugars, proteins, live cells, tissues or a combination of them. They are made from natural and living sources such as animal cells, plants, and microorganisms like bacteria and yeast.	A biosimilar is a medication that is very similar to a biologic drug already approved by the FDA - the original biologic (also known as the reference product). Furthermore, the biosimilars have no clinically significant differences from the reference product. This means that you can expect the same safety and efficacy with a biosimilar throughout a treatment as with the reference product.

Biological Product- Reference Drug	Biosimilars
Remicade	Avsola® Renflexis® Inflectra®
Avastin	Mvasi® Zirabev®
Herceptin	Kajinti ® Trazimera ® Herzuma®
Rituxan	Riabni ® Ruxience ® Truxima ®

Benefits

Drug Delivery Program for 90 days at local pharmacy

This program allows you to order an 84 to 90-day supply of certain maintenance drugs through participating pharmacies within your local pharmacy network.

If you are already stable on your treatment, ask your doctor for a 90-day supply prescription plus one (1) refill of your maintenance medications.

Step Therapy Program

This program encourages the use of first-line medications to treat your medical condition before using any other second-line medications for treatment.

First-line drugs are considered those treatment options that are supported by national clinical guidelines and standards of medical practice as alternatives to be used in initial therapy. Second-line drugs are treatment options, as are first-line drugs, but guidelines place them as alternatives to be used after first-line drugs have been used.

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