Pharmacy Services Valley Health Plan (VHP) covers all drugs that are listed in the VHP Formulary that is maintained by the VHP Pharmacy and Therapeutics Committee. VHP pharmacy benefit is managed by Navitus Health Solution. Navitus Customer Care is available 24/7 and can be reached 1- 1-333-2757. Secatiton Medically necessary non-formulary drugs may be covered by filling out an “Exception to Coverage (ETC)” form. (See Section 14 Forms & attachment). Forms can also be obtained using your NPI number through www.navitus.com or call Navitus at 1-866-333-2757. ETC form will be processed within 5 working days. Urgent ETC form will be processed within 72 hours. ETC form should be faxed to 920-735-5350. All prescriptions must be filled at a VHP network pharmacy. In case of an emergency where a VHP network pharmacy is not available, members may fill the prescription at an out of network pharmacy.
Navitus Health Solutions Operations Division - Claims P.O. Box 999 Appleton, WI 54912-0999 Dentist can prescribe only for antibiotics and pain medications. Optometrist can prescribe only for ophthalmic agents. Drug Formulary To obtain a copy of the Drug Formulary call Provider Relations at (408) 885-2221. VHP Pharmacy Benefits and Authorization Valley Health Plan uses a Formulary developed by Valley Health Plan Pharmacy and Therapeutics (P&T) Committee. The primary purpose of the Formulary is to promote efficacious and cost-effective pharmacotherapy. In most instances, medications will be dispensed by the pharmacy without the need for any intervention. However, in some instances the pharmacy will require additional information from the prescribing physician in order to dispense the medication and receive payment. When prior authorization is required for a drug, please contact Navitus at the above listed numbers.
www.valleyhealthplan.org rev.2020
Section 10
Page 35 of 68
SECTION 10: PHARMACY SERVICES
If a Member uses an out of network pharmacy, the Member must pay the pharmacy directly and submit receipts for reimbursement to:
