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Call us at 1-877-226-8500
8AM-8PM 7 days/week (TTY 711)
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CenterLight Healthcare

CenterLight's Clinical Pharmacy Management staff is responsible for the development and management of the PACE formulary, a list of medications that are covered under this plan.

Additionally, we provide comprehensive Medication Therapy Management services for eligible members and serve as a source of drug information to not only our patients, but to all healthcare professionals on the Interdisciplinary Care Team.

Please click on the following links to access information regarding our Clinical Pharmacy Programs.


Clinical Guidelines

Formulary Resources

Medication Therapy Management Program

Medication Therapy Management Triggers





Clinical Guidelines


 A. CARDIOVASCULAR ▾

1. Atrial Fibrillation

2. Heart Failure

3. Hyperlipidemia

4. Hypertension

5. Peripheral Artery Disease

6. Pulmonary Arterial Hypertension (PDF, 598KB)

7. Stroke

8. Valvular Heart Disease

9. Venous Thromboembolism













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Formulary Resources

Please click on the links below to access Formulary Resources in pdf format.

Direct Formulary (PDF, 868KB) (Last updated July 2017)

Direct Prior Authorization Criteria (PDF, 362KB) (Last Updated July 2017)

Direct Step Therapy Criteria (PDF, 141KB) (Last Updated July 2017)

PACE Formulary (PDF, 935KB) (Last Updated July 2017)

PACE Prior Authorization Criteria (PDF, 404KB) (Last Updated July 2017)

Step Therapy Criteria (PDF, 184KB) (Last Updated July 2017)

Prescription Drug Coverage Determination Form (PDF) (Coming Soon)


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Medication Therapy Management Program

CenterLight Healthcare’s Medication Therapy Management (MTM) program is multifaceted and interdisciplinary. Our comprehensive approach to MTM employs information technology, pharmacy benefit management, community pharmacists, physicians, community health nurses (CHNs), and CenterLight Healthcare clinical pharmacists. Working as a team, we are focused on optimizing therapeutic outcomes to meet the unique needs of each member.

CenterLight MTM program will review each member’s regimen for the purpose of:

  • Ensuring that prescribed medications are clinically indicated via reconciliation with listed diagnoses
  • Ensuring that the prescribed medications effectively address the condition(s) being treated
  • Ensuring that the lowest effective doses and most appropriate durations are utilized
  • Maximizing a medication’s benefits and minimizing its risks
  • Identifying medication-related causes of emerging symptoms, declines in health status, or negative outcomes and formulate a plan to remedy any adverse effects
  • Ensuring that evidence-based and cost effective therapies are utilized

All CenterLight Healthcare members will receive varying levels of MTM based on the complexity and risk of their regimens. The four levels of MTM services build on each other.

The hallmark of the MTM program at CenterLight Healthcare is the level 4 MTM review performed by a CenterLight clinical pharmacist which indicates a comprehensive medication regimen review.

    LEVEL 1

    Level 1 of the MTM program is offered to all CenterLight Healthcare members. This level involves our pharmacy benefits manager’s adjudication of claims against a database of filled member prescriptions to:

    • Confirm member demographic information including age and gender
    • Track member’s adherence to prescribed medications
    • Provide formulary support
    • Administer prior authorization and step therapy policies

    LEVEL 2

    Level 2 of the MTM program is offered to all CenterLight Healthcare members. Level 2 relates to network pharmacies that fill prescriptions for CenterLight Healthcare participants. The community pharmacist:

    • Evaluates drug-drug interactions and allergies
    • Identifies therapeutic duplications
    • Ensures that prescribed doses do not exceed FDA guidelines

    LEVEL 3

    Level 3 of the MTM program is offered to all CenterLight Healthcare members. Level 3 incorporates an interdisciplinary care team (IDT) review of the member’s regimen. This review includes:

    • Medication profile for accuracy
    • Evaluation of efficacy
    • Screening for side effects
    • Medication adherence/compliance tracking & determining need for medication prepours or compliance packaging

    LEVEL 4

    The level 4 MTM performed by a CenterLight Healthcare clinical pharmacist is a comprehensive medication regimen review and may include the following analyses:

    (The physician, member, pharmacy, or CHN may be contacted to resolve any questions that arise)

    • Medications are reconciled between the member’s medical record and pharmacy claims
    • Number of medications determined (including scheduled, as needed, prescription, over-the-counter, supplements, & herbals)
    • Drug allergy and cross-sensitivity evaluation
    • Drug or vaccine contraindication evaluation
    • Care plan review
    • Lab and radiological results are reviewed where appropriate
    • Assessment for drug dosage adjustments, or discontinuation based on renal or hepatic impairment
    • Disease-state specific evidence-based regimen reviews for medications and vaccinations
    • Drug interaction evaluations including: Drug-drug, drug-herb, drug-lab, drug-food, drug-disease state, & drug-vaccine interactions
    • Other analyses deemed necessary by the clinical pharmacist

    After the analyses are performed, the medication regimen evaluation findings and recommendations are shared with the member’s PCP or other prescriber. Medication changes will only be made after collaboration and consultation with the member’s PCP or prescribing physician.

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Medication Therapy Management Triggers

The Medication Therapy Management Program is available to all CenterLight members and includes a medication regimen review (MRR) completed by a CenterLight Healthcare clinical pharmacist.

A level 4 MTM is triggered (see above for information on MTM levels), but not limited to one or more of the following conditions being met:

  • Initial medication review
  • Transition of care medication review
  • Supportive care medication review
  • High risk medication review
  • Behavioral health medication review
  • Complexity of pharmacologic regimen
  • Member takes 8 or more chronic medications
  • Multiple comorbid disease states
  • Presence of an infectious process
  • Consultation request from member’s primary care physician (PCP) or IDT
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