Maxcare Maintenance Drug Program

“Convenience with Cost Containment”

Drugs that appear on the Pharmacy Providers of Oklahoma/MaxCare Standard Maintenance Drug List may be dispensed in multiple-month increments, up to a 102-day supply (certain plans use 90-day increments instead), when prescribed in that quantity by the prescribing physician.

Drugs available for multiple-month dispensing include drugs that are normally taken for prolonged periods of time and meet the enclosed Maintenance Drug Criteria. Additions can be made based on client wishes.

Co-Payments

Co-payments may be customized to meet client needs. A single co-payment per 3-month supply or a co-payment per month supply dispensed may be utilized. These co-payments may be a fixed dollar amount or a percentage of total Plan contact prices.

Initial Therapy Protocol

Initial Therapy of no more than a 34-day supply (certain plans use 30-day increments instead) within 120-day period is required  for beginning therapies and in each instance when the drug strength is changed, to ensure that the patient tolerates the therapy well and that medication changes do not result in wasted doses.

The MaxCare Maintenance Drug Program
is designed to provide convenience,
eliminate duplication of dispensing fees,
and control potential waste.

Maintenance Drug Criteria

Maintenance Drug: A  medication that is indicated and approved by the Food and Drug Administration (FDA) for continued therapy for a disease or illness for a prolonged period of time.

Criteria Used for Inclusion:

1. The medication is indicated and approved by FDA for prolonged therapy.
2. The side effect profile does not represent a high degree of probability of non-tolerance upon continued therapy.
3. The medication does not require physician follow-up in a time frame that prevents prolonged therapy.
4. The abuse potential of the medication does not create concerns of continued therapy.
5. The cost of the medication does not prohibit consideration for inclusion because of the possibility of waste from discontinuance or change in therapy after the medication is dispensed in a three-month supply.
6. Clinical studies do not indicate that the drug is less than effective for the indicated treatment.