Prescribers

General information verbage | Drug Formulary | Prior Authorization form

General information

PharmAvail provides progressive pharmacy benefit management services that maximize the value of employee health benefits, while improving quality of care and containing costs. We believe in bringing value to each provider of, as well as those receiving services, in a continuum of pharmaceutical care. We, however, differ from our competitors relative to our advice to plan sponsors and our construction of pharmacy plan and formulary specifics. We do not factor drug manufacturer interests or profits into our pharmacy plan, decision process. While maintaining the health needs of our members as the primary concern, we proceed in both plan and formulary development based strictly on sound clinical evidence. When independent analysis of clinical therapeutic value, drug versus drug, is nonexistent, our Pharmacy and Therapeutics team generally proceeds by recommending coverage of the most cost-effective alternative to the plan. In order to limit the potential for therapy interruption, we supply physicians and other prescribing professionals with information they need to make informed decisions. We fully understand today’s demanding health-care environment, thus we work closely with both pharmacists and physicians to make the prescription process safe and efficient.

We listen closely to our clients and their need to reduce overall costs, while ever ensuring exceptional care. We empower our members to make informed choices through educational programs, wellness offerings and strong customer service support. When formulary decisions are made that require an alternative to a member’s medication to comply with plan specifications, two plan options remain available. First, prescribers are welcome to submit for “prior authorization” of a particular medication when they deem it clinically justifiable in a particular patient. In return, we promise an efficient and professional review of each prior authorization request. If “prior authorization” of a particular medication is declined, co-payment options exist that allow members continued access to the nearly all pharmaceuticals.

Drug Formulary

Formulary List (Adobe Acrobat Reader is needed to see this file)

Prior Authorization form

Drug Prior Authorization Form (Adobe Acrobat Reader is needed to see this file)

direct member reimbursement form

Direct Member Reimbursement Form (Adobe Acrobat Reader is needed to see this file)