Preferred Drug Listing (PDL): Virginia Premier Health Plan, Inc.

Preferred Drug Listing (PDL)

Effective July 1, 2009, Express Scripts is the pharmacy benefits manager for retail prescriptions. 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 (800) 824-0898.

PDL Searchable Formulary

Download the Preferred Drug Listing (PDL)

1. Overview of PDL
2. Abridged PDL
3. Prior Authorization Listing
4. Quantity Drug Limit
5. Step Therapy Drug Listing
6. Formulary Change Alternatives
7. Express Scripts Prior Authorization Form
8. IUD Changes
9. ID Card Information
10. Pharmacy Paper Claim

Specialty Drugs

Pharmacy Benefit Manager (Pharmacy Specialty Services)

Effective July 1, 2009, AXIUM Health Care Pharmacy, Inc. is our pharmacy benefit manager for specialty pharmacy services. AXIUM’s medication therapy management program provides medications to a wide range of patient populations including the following:

◊ Growth Hormone	◊ Multiple Sclerosis	◊ Hemophilia
◊ Hepatitis	◊ Psoriasis/Dermatology	◊ Cancer (Oral and in-home Medications)
◊ HIV/AIDS	◊ IVIG	◊ Osteoarthritis
◊ Rheumatoid Arthritis	◊ and more…	◊ and more...

AXIUM’s clinical staff is comprised of Doctors of Pharmacy, Registered Nurses, dedicated Patient Care Coordinators and Reimbursement Specialist that are always available to assist your office and your patients. Program Options: stock replacement or future use. Direct reimbursement is not an option. Requests must be submitted within 72 hours of member’s appointment. Typical processing time is within 48 hours and shipped by USPS overnight. AXIUM authorization forms are available at www.virginiapremier.com. Complete the applicable form and fax to AXIUM at (800) 546-2172. If you have questions about AXIUM program, please call Nancy Patterson at (888) 315-3395, ext. 273.