Current Plan Benefit Design. The MSI Program is the payer of last resort for medically necessary medications. The formulary is posted on the MSI Program website at: xxxx://xxx.xxxxxxxxxxxx.xxx/medical/msi/providers/downloads.htm Medications are covered if they are for urgent or emergent medical conditions or for selected ongoing chronic conditions. All medications must be obtained through Contractor’s network of pharmacies or mail order system. Some medications are paid for indigent, low-income, and AIDS patients through manufacturer compassionate care programs. These pharmacy assistance programs (PAP, ADAP) are the primary payers and will cover many of the medications not on the MSI Program formulary. Physicians and patients are notified to apply to the applicable drug manufacturer to cover their medication expenses. In order to formalize the medications covered, the MSI Program has developed a formulary. This formulary is restrictive in that only those medications on the formulary list are covered. Further, payments are restricted to generic formulations and/or step therapy medications when they are available. Generics, whether they are available from one or more manufacturers, are covered on the restrictive list. Exclusions from the formulary include medications not listed in the formulary, over- the-counter medications and specific therapeutic classifications relating to conditions outside the scope of the MSI Program. The MSI Program in rare cases may cover a non-formulary drug where one of the following conditions is present:
