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2025 MPSERS Medicare Approved Drug List

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Mpsers Current Year

Page last updated on: 3/27/25

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2025 MPSERS Approved Drug List

Some drugs may require your provider to fill out an authorization form.

2025 Medicare Part D prior authorization criteria
2025 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.

Learn how to request a drug redetermination (appeal).

ePA Information

Injectable drugs Site of Service policy and billing guidelines

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Approved drug list

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Enrollees may receive a copy of their Form 1095-B upon request by calling the customer service number on the back of their Member ID card, by logging into their Priority Health member account or by mailing in a request to Priority Health,1231 East Beltline Ave. NE, Grand Rapids, MI 49525-4501.