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 Prescription Drug Plan

WVCHIP provides its members with prescription drug benefits. Prescription drug benefits are administered by Express Scripts, Inc. (ESI).  Enrolling a child in the Plan atutomatically enrolls them in the prescription drug plan.

 

New Preferred Drug List for WVCHIP Members

 

The West Virginia Children’s Health Insurance Program updates the Preferred Drug List (PDL), annually. Click here for the current WVCHIP Preferred Drug List.

Non-preferred drugs will not be covered.  If a provider chooses to prescribe a drug not listed on the Preferred Drug List (PDL), it will be a 100% retail cost to the patient.  Co-payments for drugs on the new PDL will remain the same.  Questions concerning drugs covered by WVCHIP should be directed to Express Scripts, Inc. (ESI) at
1-877-256-4689.

Rational Drug Therapy Program Now Reviews Prior Authorization Drug Requests

Effective July 1, 2005, the West Virginia University School of Pharmacy's Rational Drug Therapy Program assumed review authority for all prior authorization requests for West Virginia Children's Health Insurance Program (WVCHIP).

This change affects the administrative process of prior authorizations only.  The list of drugs that require prior authorization has not changed.

Contact the West Virginia University School of Pharmacy, Rational Drug Therapy Program, for all prior authorization reviews, at 1-800-847-3859.

The process is typically resolved over the phone. If done by letter the process can take up to two business days.

The following link is for providers who want to print out the Prior Authorization Form to submit to the Rational Drug Therapy Program:  Prior Approval Request Form.

Please note that four medications now require Prior Authorization through RDTP for children under the age of six with diagnosis of ADHD.  These medications are:  Adderall XR, Concerta, Ritalin, and Strattera.  Those already established on these medications prior to August 1, 2009, may continue to receive these medications, however, prior authorization must be renewed annually.

To download a printer friendly PDF version of the ADD Medication Prior Approval Request Form click here.

Pharmacists can dispense up to a five-day supply of a medication requiring prior authorization for the applicable copayment.  This policy applies when the doctor is either unavailable or temporarily unable to complete the prior authorization process promptly. If the prior authorization is ultimately approved, the pharmacist will be able to dispense the remainder of the approved amount with no further copayment for that month's supply if the member has already paid the full copayment.

 

 

Common Specialty Medications

 

We've also changed the way we cover these high-cost drugs. All members using these drugs were notified prior to implementation.

This means member will only be able to purchase these specialty medications through CuraScript, and the medication will be mailed to the member's home or physician's office. Most often these are self-administered injections.

Please refer to the list of the most "Common Specialty Medications" below. These drugs are not available in 90-day supplies.

In addition to providing these specialty medications to our members, CuraScript offers:

  • A Patient Care Coordinator who serves as your personal advocate and point of contact.
  • Delivery of your specialty medications directly to you or your doctor.
  • Supplies to administer your medications - at no additional cost.
  • Care management programs to help you get the most from your medications.

 

Contact CuraScript toll-free at 1-866-413-4135
(8 a.m. - 9 p.m., Eastern time, Monday-Friday and 9 a.m. - 1 p.m. , Eastern time, Saturday).

 

 

Drug Name

 

 

Category

 

   
Acthar Multiple Sclerosis
Aldurazyme Mucopolysacchardosis
Aranesp [PA] Anemia
Arixtra Anti-Coagulant
Avonex Multiple Sclerosis
Betaseron Multiple Sclerosis
Bicillin C-R Anti-Infectives
Botox [PA] Migraine, Cerebral Palsy
Cerezyme Gaucher Disease
Copaxone Multiple Sclerosis
Copegus Hepatitis C
Desferal Diagnostic
Enbrel [ST] Rheumatoid Arthritis
Epogen [PA] Anemia
Fabrazyme Fabry Disease
Fortaz Anti-Infectives
Forteo [PA] Osteoporosis
Fragmin Anti-Coagulant
Fuzeon HIV
Genotropin [PA] Growth Hormone
Geref [PA] Growth Hormone
Humatrope [PA] Growth Hormone
Humira [ST] Rheumatoid Arthritis
Infergen Hepatitis C
Innohep Anti-Coagulant
Intron A Interferons
Iressa Anti-Neoplastic
Kineret [ST] Rheumatoid Arthritis
Leukine Hematopoietic
Leuprolide [PA] Anti-Neoplastic
Lovenox Anti-Coagulan
Lupron [PA] Anti-Neoplastic
Lupron Depot [PA] Endometriosis, Anti-Neoplastic, Precocious Puberty
Myobloc [PA] Neurologic
Neulasta Neutropenia
Neumega Hematopoietic
Neupogen Neutropenia
Norditropin [PA] Growth Hormone
Nutropin [PA] Growth Hormone
Pegasys Hepatitis C
Peg-Intron Hepatitis C
Procrit [PA] Anemia
Protropin [PA] Growth Hormone
Pulmozyme Cystic Fibrosis
Rebetol Hepatitis C
Rebetron Hepatitis C
Rebif Multiple Sclerosis
Ribavirin Hepatitis C
Rimso-50 Anti-Neoplastic
Rocephin Anti-Infectives
Roferon-A Anti-Neoplastic
Saizen [PA] Growth Hormone
Sensipar Hyperparathyroidism
Serostim [PA] Growth Hormone
Tarceva Anti-Neoplastic
Temodar Anti-Neoplastic
Tev-Tropin [PA] Growth Hormone
Thalomid Anti-Neoplastic
Thyrogen Kit Diagnostic
Tobi Cystic Fibrosis
Xeloda Anti-Neoplastic
Zavesca Gaucher Disease
Zorbtive [PA] Growth Hormone

 

Drugs Requiring Prior Authorization

Several classes of prescription drugs require prior authorization for coverage by WVCHIP.  The prior authorization process will involve the child’s physician and pharmacist communicating with WVU’s School of Pharmacy, Rational Drug Therapy Program (RDTP), about the situation, since these prior approvals are given on a case-by-case basis. The child's doctor must call RDTP.  If your medication is not approved for plan coverage, you will have to pay the full cost of the drug. WVCHIP will cover, and your pharmacist can dispense, up to a five-day supply of a medication requiring prior authorization for the applicable copayment. This policy applies when your doctor is either unavailable or temporarily unable to complete the prior authorization process promptly.

 

Prior Approval for Medicine for Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder

 

Prior Authorization Policy - Therapeutic Guidelines

WVCHIP has added stimulants, amphetamines and atomoxetine to the list of medications that need prior approval through the Rational Drug Therapy Program (RDTP).  The goals of this therapeutic guideline policy is to promote overall disease management such that medication treatment is supported by adjunctive psychosocial programs, ample patient contact, and frequent follow-up visits throughout the course of therapy to address non-medication treatment alternatives, comorbid disorders, dosage titration, adverse effects, and drug diversion and misuse.

In order to simplify the process for the providers, we have revised an RDTP prior approval form and changed it to specifically address the ADHD/ADD prior approval process.

Prior Approval Request Form for Attention Deficit Disorder Medication  


Frequently Asked Questions

Q.  Who do I call about prescription drug coverage?

A. Contact Express Scripts, Inc. at 1-877-256-4680 or visit them online at ExpressScripts.com. Click here for the current WVCHIP Preferred Drug List.

Q. Who do I call to preauthorize prescription drug coverage?

A. Contact WVU's Rational Drug Therapy Program at 1-800-847-3859.

 

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