Virginia Premier Health Plan, Inc.

Pharmacy Specialty Drugs

Specialty drugs are high-cost injectable, infused, oral, or inhaled medications that are typically prescribed to treat complex chronic or long-term conditions that have few or no alternative therapies, such as cancer, HIV/AIDS, hepatitis C, multiple sclerosis, and others.

People who take specialty drugs require customized clinical monitoring and support to reduce their health risk and potentially serious side effects.

Most Specialty drugs require prior authorization whether self-administered, administered in the office or by a home health service. Authorizations are based on medical necessity, which is determined by the drug policy, evidence-based medicine, state benefits, regulations, contracts and medical judgment.

Providers may obtain an approval for Specialty drugs by calling: Envision RxOptions at 855-872-0005.

Faxing Envision RxOptions PA form.

Once prior authorization is obtained, providers will be informed about the options for specialty drugs; using the preferred Specialty vendor, using office stock or when appropriate, home health nursing services.

Effective July 1, 2012, Specialty Pharmacy services will be provided by multiple preferred specialty pharmacy vendors. All Prior Authorizations will be administered through Envision RxOptions at 855-872-0005.

Specialty Pharmacy drug list

Preferred Specialty Pharmacy Vendors list

Forms

Compound Preservative-Free 17P order form

Envision Rx Options General Prior Auth Form

AMBER Specialty Drug Form-Va Premier

AMBER Hep C Form Va Premier

AMBER Oncology Intake Form Va Premier

AMBER Revlimid Intake Form Va Premier

AXIUM Drug Order Form Va Premier

AXIUM Dermatology Form Va Premier

AXIUM Growth  Hormone Form Va Premier

AXIUM Multiple Sclerosis Form Va Premier

AXIUM Rheumatology Form Va Premier