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VHP covers medications and pharmaceutical supplies listed in the VHP formulary that are considered VHP-preferred prescription drugs in accordance with the member’s Evidence of Coverage (EOC). VHP contracts with Navitus Health Solutions (Navitus), a pharmacy benefit management (PBM) company, to administer the prescription drug benefit. Navitus processes claims, prior authorization requests, and provides customer service on behalf of VHP to VHP members. Navitus Customer Care is available to answer providers’ pharmacy benefit questions at 1.866.333.2757, 24 hours per day, seven days per week (except Thanksgiving Day and Christmas Day).
Drug Formulary VHP’s drug formulary is the list of prescription drugs that has been reviewed, selected, and approved by VHP and its Pharmacy and Therapeutics Committee (P&T) in accordance with national standards of care. The formulary is updated monthly and posted on the following websites: VHP: www.valleyhealthplan.org/sites/p/fr/Pages/Pharmacy/Formulary.aspx Navitus: https://prescribers.navitus.com/vhp The formulary includes both brand name and generic equivalent drugs, all of which are approved by the Food and Drug Administration (FDA). Generic drugs are identical or bioequivalent to a brand name drug in dosage, form, safety, strength, route of administration, quality, performance characteristics, and intended use. Providers should refer to the formulary to determine coverage of smoking cessation, over the counter (OTC) medications, and other covered medications. VHP covers formulary medication and supplies prescribed by licensed providers within the scope of their practice. VHP providers are essential to the appropriate use of pharmaceuticals. The prescribing provider’s responsibilities include: • Selecting the best, most economical drug, and dosage form to treat the member's condition; • Ensuring each member clearly understands the drug's use, the correct dose and possible side effects; • Reviewing and reconciling the member’s medication list, including dosages, drug interactions, duplicate therapy, and non-adherence to prescribed therapies; • Discontinuing ineffective drugs; and • Carefully monitoring therapeutic drug levels, as necessary. Note: Certain medications prescribed by dentists and optometrists within their scope of practice may be covered on the formulary. Dentists may only prescribe for antibiotics and pain medications. Optometrists may only prescribe for ophthalmic agents.
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CH 16: Pharmacy Services
2021 / Provider Manual
