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Virginia Premier Health Plan, Inc.

Pharmacy Drug Listing (PDL)

The formulary and prior authorization forms are listed below in the attached links. If you have any questions regarding the formulary or requesting prior authorization, please call Envision RxOptions at 855-872-0005.

PDL Searchable Formulary

1. PDL - formulary

2. Overview of PDL

3. Abridged PDL

4. Prior Authorization Listing

5. Quantity Drug Limit

6. Step Therapy Drug Listing

7. Envision Prior Authorization Form

8. IUD Changes

9. ID Card Information

10. Pharmacy Paper Claim

Download the Full Preferred Drug List

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