"We are your ally in services and solutions for the patient's well - being." -
"We work for the patient´s well - being and the rational use of medications." -
"We focus on the rational use of medications, with the goal of optimizing the clinical processes while reducing their cost." -

In MC-21 we distinguish ourselves by making available to doctors a wide range of services and programs.

Request for formulary inclusion or exclusion of medications

As a physician, you can make recommendations for our formularies. For requesting the inclusion or exclusion of a medication, please write to: druginfo@mc-21.com or call 1-877-741-7470.

Specialty Medication Management Program

This program is for the management of medications to treat chronic and high risk conditions that require a specialty pharmacy network. These pharmacies implement clinical interventions, dispense medication, and provide educational support to patients about the conditions that affect them.

Some of the conditions included in this program are:

  • Multiple Sclerosis
  • Crohn´s Disease
  • Gaucher´s Disease
  • Growth Hormone Deficiencies
  • Hemophilia, Von Willebrand Disorder and other blood disorders
  • Hepatitis C
  • Cancer
  • Osteoporosis
  • Osteoarthritis
  • Psoriasis
  • Pulmonary Hypertension
  • Rheumatoid Arthritis
  • Respiratory Syncytial Virus Prevention (RSV)
Prior Authorization Management

This program is supervised by experienced clinical pharmacists, and is focused on evaluating if medications requiring prior authorization comply with the clinical criteria approved by a Pharmacy and Therapeutics Committee that oversees their appropriate use.

In addition, certain administrative criteria are evaluated for prior authorizations, such as cost and travel, among others.

Clinical Quality Improvement Program

Our expert pharmacy clinicians have developed a wide range of clinical programs aimed at promoting patient safety, the effective utilization of drugs, and, most importantly, to identify any potentially inappropriate use of therapy. Our programs are focused toward improving the quality of patients´ care, the physician´s prescription patterns, and the pharmacy dispensing activities. We believe that education is the cornerstone to prevent medication errors. Therefore, MC-21 has implemented a communication process that includes sharing the news posted by the Federal Food and Drug Administration (FDA) on medication safety and recalls. For detailed information on how our Clinical Quality Improvement Program can help you, please call 1-877-741-7470.

Medication Therapy Management Program

Designed to satisfy the needs of patients with Medicare Part D coverage, this program offers services through an interdisciplinary clinical team for treating chronic conditions such as asthma, diabetes, COPD, hypertension and hypercholesterolemia. It focuses on optimizing the therapeutic results through orientation in the adequate use of medication and the reduction of serious side effects, including adverse medication interactions.

Medication Adherence Program

This program is focused on improving patient´s service quality by providing ways for them to stay in their treatment. The program aims at integrating all patient's care participants in promoting therapy adherence, guarantee the appropriate use of medications, and insure a top level of care and satisfaction while helping patients manage their conditions.

Formulary Management

Our formulary management starts with our Pharmacy and Therapeutics Committee (P&T). Our P&T is comprised of Board Certified Specialists and Clinical Pharmacists whom are experts in diseases, drugs, and treatment protocols. This Committee promotes safe and effective medication use based on latest scientific data available and current standards of medical practice.

As part of our clinical oversight process, this multidisciplinary, multispecialty group of health care professionals is responsible of the design, implementation, and monitoring of all aspects of medication use to improve both the quality of care and the cost-effectiveness of the formularies. They review for clinical appropriateness the practices and policies for formulary management activities such as prior authorizations, step therapies, quantity limitations, generic substitutions, and other drug utilization activities.

If you need additional information you may contact the MC-21 Drug Information Center, available through a toll-free hotline, Monday through Friday from 8:00 am to 6:00 pm, at 1-877-741-7470, or contact us at druginfo@mc-21.com. Pharmaceutical personnel will gladly provide assistance.

E-Prescribing

The E-prescribing program gives physicians real time information on eligibility, clinical and in formulary, patients´ past and current medication history, safety alerts on drug interactions and drug allergies, and other medication related problems. This information is available to physicians at prescription time, which promotes the integration of patients´ pharmacy benefits such as mail ordering, prior authorizations and compliance, among others. E-prescribing improves the safety of patients and physician´s care.

Physicians Education Program

This program is based on the current clinical guidelines and supports physicians in the selection of the most adequate and cost effective pharmacological treatment for their patients. By using in-person meetings, this initiative improves knowledge about medications´ cost and coverage, at the same time providing the orientation from MC-21 specialists on the design of health plans, specific information on pharmacy benefits programs, formularies and market trends. The physicians´ education program promotes prescription patterns that conform to the current clinical guidelines and improve the quality of medical care, among others.

Drug Information Center

This center is staffed with clinical pharmacists that offer support in formulary management. It maintains constant communication with providers and brings the most recent information about therapies, trends and cost control mechanisms. The center is a unique tool that gives the provider access to advisors and relevant information to support his/her medication selection process.
Through the Center, physicians can request the inclusion of certain products in the formulary and follow-up on their status. They can obtain information about medications and therapies, require clinical literature, know about medication availability and identify medications in other markets, among other services.

For access to clinical advisors, please call toll free number 1-877-741-7470, Monday through Friday, from 8:00am through 5:00pm or write to druginfo@mc-21.com.

Retail Pharmacy Networks

MC-21 retail pharmacy network includes over 900 pharmacies in Puerto Rico and more than 69,000 in the United States, as well as a mail order pharmacy network. We also have the Flex 90 program, a 90-day maintenance medication dispensing program in a single pharmacy visit. This program is available in our pharmacy networks in Puerto Rico and the United States. The patient should discuss the convenience of this option with his/her physician.

Specialty Pharmacy Networks

Our specialty pharmacy network, which operates through local pharmacies, integrates the implementation of clinical interventions in the management of chronic conditions requiring special treatment and management. In addition to clinical interventions, these pharmacies dispense the medications and provide educational support to patients helping them manage their health conditions.

Mail Order Pharmacy Network

For members that request it and qualify, some maintenance medications for certain therapies could be conveniently available by mail order and delivered to their homes. Maintenance medications are those used to treat long-term conditions such as diabetes, hypertension and cholesterol, among others.

If the member´s health plan includes the mail order portion, there are three ways to receive the medication ordered:

US Pharmacy Network

There is an extended network in the United States that includes nearly 70,000 pharmacies.

Fraud Waste and Abuse Program

The Fraud, Waste and Abuse Program (WFA), in support of MC-21´s pharmacy network, consist of three main components: Prevention, Detection and Correction. We have a Pharmacy Education Program in place which goal is to keep our pharmacy network updated on how to prevent, identify and report potential fraud, waste and abuse cases. Every person has the right, obligation, and responsibility to inform about suspicious activities or possible violations of fraud, waste and abuse guidelines and regulations. Information can be given confidentially through the following channels:

Telephone- (787) 286-6032
Hotline- Extension 3800
FWA Unit- Extension 3122
Fax- (787) 653-2854
E-mail- cumplimiento@mc-21.com
Mail- Call Box 4908
Caguas, PR 00726