2024 MPSERS Approved Drug List
Downloads
Some drugs may require your provider to fill out an authorization form.
- Medicare Part D prior authorization criteria
- Medicare Part D step therapy criteria
- Request for Medicare Part D coverage determination
- Medicare Part B vs Medicare Part D coverage determination form
- Hospice coverage determination form
Drugs covered under the medical benefit
- Medical Benefit Drug List (MBDL) (formerly the Injectable Drug List)
- Medicare Part B prior authorization criteria
- Medicare Part B drug request form (non-oncology)
- Medicare Part B oncology drug request
Medical drug-specific forms are linked in the Medical Benefit Drug List.
Electronic prior authorization
Learn how to request a drug redetermination (appeal).