Medicare Advantage Prescription Drug Resources

High Performance Formulary

High Performance Formulary 

View the High Performance Formulary that applies to:

• MedMutual Advantage Choice (HMO) 
• MedMutual Advantage Classic (HMO) 
• MedMutual Advantage Plus (HMO) 
• MedMutual Advantage Signature (HMO) 
• MedMutual Advantage Access (PPO) 
• MedMutual Advantage Select (PPO) 
• MedMutual Advantage Preferred (PPO) 
• MedMutual Advantage Premium (PPO) 

EGWP Group Formularies for:

Medical Mutual offers Employer Group Waiver Plans (EGWP) coverage to the following groups:

• Kaiser Permanente
• Fasteners Industries, Inc.
• Howmet Aerospace, Inc.
• Diocese of Cleveland
• Bon Secours Mercy
• MMO Retirees
• Oberlin College
• Case Western Reserve University
• University Hospitals
• Postal Service Health Benefits Program

View EGWP formularies by visiting the MedMutual Advantage Group Plan Information page and entering the group number listed on the member's ID card.

Prior Authorization

We require prior authorization for certain drugs. Specific clinical criteria will need to be met for use of these drugs. Learn more about prior authorization guidelines for different prescription drugs using the resources below.

For EGWP prior authorization information, visit the Group Plan Information page and enter the group number listed on the member’s ID card.

View the [prior authorization link coming soon (pending CMS review)]

• MedMutual Advantage Classic (HMO)
• MedMutual Advantage Choice (HMO)
• MedMutual Advantage Plus (HMO)
• MedMutual Advantage Signature (HMO-POS)
• MedMutual Advantage Access (PPO) 
• MedMutual Preferred (PPO)
• MedMutual Premium (PPO)
• MedMutual Advantage Select (PPO)

Quantity Limits

For certain drugs, we limit the amount of the drug that we will cover per prescription or for a defined period of time. For a list of quantity limits, please refer to our complete listings below.

For EGWP quantity limit information, visit the Group Plan Information page and enter the group number listed on the member’s ID card.

View the quantity limits list that applies to:

• MedMutual Advantage Classic (HMO)
• MedMutual Advantage Choice (HMO)
• MedMutual Advantage Plus (HMO)
• MedMutual Advantage Signature (HMO-POS)
• MedMutual Advantage Access (PPO)
• MedMutual Preferred (PPO)
• MedMutual Premium (PPO)
• MedMutual Select (PPO)

Step Therapy

In some cases, we require patients to first try one drug to treat a medical condition before we will cover another drug for that condition. Learn more about the criteria for step therapy below.

For EGWP step therapy information, visit the Group Plan Information page and enter the group number listed on the member’s ID card.

View the [step therapy guidelines link coming soon (pending CMS review)]:

• MedMutual Advantage Classic (HMO)
• MedMutual Advantage Choice (HMO)
• MedMutual Advantage Plus (HMO)
• MedMutual Advantage Signature (HMO-POS)
• MedMutual Advantage Access (PPO)
• MedMutual Preferred (PPO)
• MedMutual Premium (PPO)
• MedMutual Advantage Select (PPO)