Pharmacy Benefits for Premier Health Insurance in Virginia
Virginia Premier’s pharmacy benefit covers prescription medications for your patients.
Virginia Premier’s prescription drug benefit is administered by EnvisionRxOptions. The team at EnvisionRxOptions can help answer any questions you may have regarding medication coverage.
Forms & Documents
All of our pharmacy forms and documents can be found in our Provider Document library.
The easiest way to find out if a prescription drug is covered is to use Virginia Premier’s searchable formulary below. Simply type in the name of your medication and click ‘search.’
A complete, downloadable formulary can be found in our Provider Document library.
Notes displayed by the medication name in the searchable formulary will indicate if that drug requires prior authorization, step therapy, or has a quantity limit.
If you have any questions about the formulary or covered drugs, please contact EnvisionRxOptions at 855-872-0005.
If your patient’s medication requires prior authorization, please contact EnvisionRxOptions to submit information for approval. Necessary forms can be found in our Document Library
Prior authorization forms can be faxed to EnvisionRxOptions at: 877-503-7231.
Prior authorizations can also be handled by phone with EnvisionRxOptions at: 855-872-0005.
Prior authorizations can also be initiated online through Envision’s coverage determination tool, PromptPA, below or to open in a new browser window here. This form can be filled out by a member, a member’s appointed representative or the prescribing doctor/provider. If the window doesn’t open right away, check for a Pop-up blocker that is stopping it or hold the “ctrl” key while you click the link.
NOTE: Virginia Premier Medallion 3.0 and FAMIS (Medicaid) members will need to add ‘*VPHP’ to the end of the member ID number when using the Envision PromptPA tool.
For example:
Medicaid members: 12345678912*VPHP
If your request for prior authorization is denied, Virginia Premier will send you and your patient a letter informing you why it was denied and how to appeal the decision if you choose to do so. For more information on appeals, please click here.
Many essential and routine generic over-the-counter (OTC) medications are a covered benefit. To download a list of OTC drugs covered by Virginia Premier, click here.
Note: OTC medications are NOT a covered benefit for FAMIS members except for the following: Omeprazole, Loratadine, Cetirizine, Ketotifen, and Permethrin.
Test strips, lancets, meters, control solutions and insulin pump supplies are covered under Virginia Premier Health plan. All require a prescription from a prescriber. Insulin, syringes and alcohol swabs are also covered under the pharmacy benefit at local pharmacies with a prescription.
Our preferred vendors for meters (Glucometers) are Abbott and Bayer. Strips, lancets, and control solutions are covered under the pharmacy benefit at your local pharmacy. Your patient can receive a free meter of choice from ABBOTT by calling 1-866-224-8892 or from BAYER by calling 1-800-401-8440. Insulin pumps are subject to Medical Necessity and available through DME (Durable Medical Equipment) vendors.
Our goal is to provide you with the best care. If you have any questions about your plan coverage, please contact Virginia Premier member services at 1-800-727-7536.