EnvisionRx Plus drug plans use a preferred drug list or formulary. The formulary is a list of drugs covered under your EnvisionRx Plus plan.
The EnvisionRx Plus formulary uses tiers, or levels, to indicate which drugs are available at what price or co-payment.
The formulary is reviewed and updated on a regular basis by a team of healthcare professionals. If the formulary changes, affected beneficiaries will be notified.
Prior Authorization
Some medications may require a prior authorization before they can be filled. These drugs are indicated on the formulary with the symbol "PA" after the drug name.
Quality Assurance
EnvisionRx Plus may require you to try certain drugs to treat your condition before we will cover another drug to treat your condition. For example, if Drug A and Drug B both treat your medical condition, EnvisionRx Plus may not cover drug B unless you try Drug A first. If Drug A does not work for you, EnvisionRx Plus will then cover Drug B. these drugs are indicated on the formulary with the letters ST in the Utilization Management Column.
EnvisionRx Plus limits the amount of the drug that EnvisionRx Plus will cover. For example, EnvisionRx Plus provides 6 per prescription for Imitrex tablets. This may be in addition to a standard one month or three month supply.
Grievance & Appeals
If you require a medication that is not on the EnvisionRx Plus formulary and you cannot use a formulary alternative, you have the right to request a coverage determination. The coverage determination process is outlined in the Grievance & Appeals policy.
The Evidence of Coverage provides information about coverage determinations, grievances and appeals in Sections 7 and 8.
You can appoint a representative to act on your behalf by providing us with a completed Appointment of Representative Form.
If you have further questions about your covered medications, please feel free to contact customer service at 1-866-250-2005 (TTY Users should call 1-866-763-9630), 24 hours a day, 7 days a week.
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