The Jai Medical Systems Managed Care Organization Formulary is available online through Formulary Navigator.

Access to the formulary is free and is available at The formulary can also be found below

Jai Medical Systems Formulary 2020

New: CY2020 HIV/AIDS Medication Formulary

Requests for a print edition of Jai Medical Systems’ Formulary can be made to our Customer Service Department at 1-888-JAI-1999.

Special Notice- Opioid Prescription Policy Changes

Referral Resource: Beacon Health Options Maryland
In partnership with our HealthChoice managed care organizations, Maryland Medicaid’s Opioid Drug Utilization Review Work group is hosting provider training sessions on Medicaid’s new opioid prescription policy. Providers need only attend one session, but session space is limited.
More Information
DHMH and MCO Notice regarding Opioid Policy Changes
Notice to Prescribers regarding Jai Medical Systems’ Opioid Prescription Policy 
Opioid PA QLL Chart

Formulary Change Notice

Formulary Change Notice 10 01 20
Formulary Change Notice 07 01 20
Formulary Change Notice 04 20 20
Formulary Change Notice HIV – 12 09 19
Formulary Change Notice Hep C – 12 09 19
Formulary Change Notice – 06 17 19
Formulary Change Notice – 05 29 19
Formulary Change Notice – 04 01 19

Pharmacy Resources

Searchable Preferred Drug List including generic availability
Find an In-Network Pharmacy

Prescription Prior Authorization

Providers interested in completing a Prescription Prior Authorization may download a form here. Members who need to request an exception for a medication that is not covered on the formulary may also download the form below for their provider to fill out and submit.
Prescription Prior Authorization Form
Unified Opioid Prior Authorization Form

Prior Authorization for Hepatitis C Therapy will require completion of the forms below. For your convenience, we have also posted the Hepatitis C clinical criteria below.
Hepatitis C Preferred Agents
Update to Criteria – Allowed Length of Treatment for Mavyret
Hepatitis C Treatment Agreement Form
Clinical Criteria for Hepatitis C – Effective 8.1.2020
Hepatitis C Treatment Prior Authorization Form – 8.1.2020
Clinical Criteria for Hepatitis C – Effective 1.1.2020
Hepatitis C Sample Treatment Plan – 12.2015

Information related to our Prior Authorization criteria and Utilization Management procedures for our formulary can be found below.
Prior Authorization Criteria
UM Procedures for Formulary


Special Notice—Asthma Controller Medications

To aid in patient compliance and effectiveness of treatment, Jai Medical Systems is increasing the allowed days supply rule for certain asthma controller medications. If your patient is on a formulary asthma controller medication, you may now write for up to a 90 day supply. You may also give the patient up to 3 refills. This is true for formulary medications, with or without a prior authorization.

If your patient is on a non-formulary medication that has been approved based on medical necessity, they too may receive up to a 90 day supply. New authorizations for medical necessity will be required, as appropriate.