Medicare Advantage Prescription Drug Resources

High Performance Formulary

High Performance Formulary 

View the High Performance Formulary that applies to all MedMutual Advantage PPO, HMO, and HMO-POS Plans.  

EGWP Group Formularies for:

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

• Bon Secours Mercy
• Case Western Reserve University
• Diocese of Cleveland
• Fasteners Industries, Inc.
• Howmet Aerospace, Inc.
• Kaiser Permanente
• MMO Retirees
• Oberlin College
• Postal Service Health Benefits Program
• Sisters of Notre Dame
• Teamsters Local 20
• University Hospitals

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 guidelines coming soon that apply to all MedMutual Advantage PPO, HMO and HMO-POS plans.

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 coming soon that applies to all MedMutual Advantage PPO, HMO, and HMO-POS plans. 

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 coming soon that apply to all MedMutual Advantage PPO, HMO, and HMO-POS plans.