Pharmacy Services at VHP

Pharmacy Benefits
Valley Health Plan pharmacy claims are processed by Express-Scripts, one of the nation's largest pharmacy benefit management companies. As an Express Choice member, link to member.express-scripts.com and visit My Pharmacy Benefits Planner, an on-line service for managing your pharmacy needs. You can check on your current pharmacy benefits and claim history; locate plan-participating pharmacies; find out about various drug comparisons, interactions and side effects; and access hundreds of timely articles on pharmacy and health-related concerns.

At Valley Health Plan, coverage for prescription drugs is considered when they are dispensed through an Express Scripts (ESI) participating pharmacy.

Pharmacy Provider Directory

You may download a printable copy of VHP's Pharmacy Provider Network in Wisconsin and Nationwide here. You will need the Adobe Acrobat Reader software to view and print the directory. If you do not have this software, you may download it here.
  

Valley Health Plan maintains a list of medications whereby members are allowed to obtain a three-month supply. At the discretion of Valley Health Plan, medications are placed on this list according to diagnosis, prescribing frequency and generic availability. If your medication is on the list, please consult your pharmacist when ordering a prescription fill. If your prescription has enough refills, your pharmacy can give you a three-month supply. Generic drugs will be used whenever possible. Your copay will be determined at the point of sale according to your prescription benefit.

Three-Month Medication Supply List

You may download a printable copy of the Three-Month Medication Supply List here. You will need the Adobe Acrobat Reader software to view and print the list. If you do not have this software, you may download it here.
  

Drug Formulary
Prescription drugs are limited to VHP's drug formulary, unless VHP and the network physician determine non-formulary medications are medically necessary and the medications are not listed as exclusions under the policy.

The drug formulary is a list of medications intended for use by our plan physicians and pharmacists. The formulary helps the physicians to assess effectiveness of a drug and maintain cost for the plan and the members.

VHP Member Drug Formulary

You may download a printable copy of our member drug formulary here. You will need the Adobe Acrobat Reader software to view and print the formulary. If you do not have this software, you may download it here.
  

Claim Form for Coordination of Benefits
If you or your family are covered under more than one insurance plan and Valley Health Plan is considered the secondary plan, you will need to pay your portion of the prescription and submit your prescription receipt along with a claim form to Express Scripts for eligible reimbursement.

Valley Health Plan's prescription coverage may not follow the same guidelines as your primary insurance. There may be differences in covered medications, quantity limits, etc. When processing your prescription claims for VHP secondary coverage, Express Scripts will administer your benefits according to VHP's prescription guidelines.

Express Scripts Claim Form

You may download a printable copy of the Express Scripts Claim Form here. You will need the Adobe Acrobat Reader software to view and print the claim form. If you do not have this software, you may download it here.