Prescription Drugs

EnVisionRx Options is the administrator of the University’s prescription drug insurance plan.  Members have access to a thirty day supply of medication when filled at a pharmacy such as Walgreens, CVS, or Giant Eagle.  By registering on EnVisionRx’s website, members can:

• Review benefits information
• Review prescription drug claims
• Prior Authorization Status
• Locate in-network pharmacies
• Other plan documents

Members may contact EnVisionRx Member Help Desk by calling 800-361-4542 or by visiting www.envisionrx.com.

Orchard Pharmaceutical Services is the prescription mail order vendor for EnVisionRx Options.   Members have access to ninety day supply of medication through Orchard’s mail-order service with no shipping or handling fees for standard delivery.  By registering on Orchard’s website, members can:

• Order & refill mail order prescriptions
• Authorize credit cards for future orders
• View mail order prescription history
• Gain access to medication information

Members may contact Orchard Pharmaceutical Services at 866-909-5170 or by visiting www.orchardrx.com.

Costco Specialty Services is the prescription drug vendor for specialty and biopharmaceutical prescriptions. Specialty medications frequently require refrigeration, time-sensitive delivery, or special preparation by an expert pharmacist.

Members may contact Costco Specialty Services at 866-443-0060.

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1.    Pharmacy Locator 

EnVisionRx contracts with both independent and national pharmacies including Walgreens, CVS, Giant Eagle Pharmacy, Wal-Mart Pharmacy, and Target Pharmacy.  

2.    Direct Member Reimbursement Form

This claim form is to be used only when it has been necessary to purchase prescriptions because your participating pharmacy did not honor your identification card or was unable to directly submit your claim. It should also be used when it was necessary to have your prescriptions filled at a non-participating pharmacy.

3.    Over the Counter Medications with Zero Copay  

With a prescription, members can access several popular over-the -counter medications at no cost.

4.    Smoking Cessation Medication with Zero Copay 

With a prescription, members and their spouse/partner can access certain smoking cessation medications at no cost. These medications are subject to a $500 lifetime maximum benefit.

5.    Medications that Require Prior Authorization  

Some medications require a prior authorization before they can be filled.  If you have been prescribed a drug that requires prior authorization, please contact EnVisionRx Options Help Desk at 800.361.4542 before going to the pharmacy.  EnVisionRx will contact your physician; there is no paperwork for the member to complete.   To request a prior authorization, contact the EnVisionRx Options Help Desk at 800.361.4542.

6.    Medications that Require Step Therapy 

This prescription drug plan may require you to try certain drugs to treat your condition before the plan will cover another drug to treat your condition. For example, if Drug A and Drug B both treat your medical condition, the plan may not cover drug B unless you try Drug A first. If Drug A does not work for you, the plan will then cover Drug B.  Members may obtain prior authorization to obtain medications that normally require step therapy where medically necessary by contacting the EnVisionRx Options Help Desk at 800.361.4542.

7.    Preferred Drug Formulary List 

EnVisionRx Options has created a preferred drug list to promote clinically appropriate utilization of pharmaceuticals in a cost-effective manner.  The preferred drug formulary list is developed based on safety, efficacy, clinical utility (comparison studies, indications, compliance, contraindications, etc), outcomes, and cost.

• 2012 Commercial Non-Maintenance Formulary Change Memo
• 2012 Commerical Formulary Change Memo

8.    Mandatory Generic Policy  

If the member or the physician wishes to use a brand name drug when a US Food and Drug Administration determined therapeutically equivalent (“AA” or “AB” rated) generic is available, the member will pay the difference in the brand name and generic medication price, plus the generic co-payment. Members may still elect to use brand name medications if they choose, but they will be required to pay the difference in the brand name and generic medication price, plus the generic co-payment 

9.    Understanding Generic Medications 

When a generic drug is approved by the U.S. Food and Drug Administration, it has met rigorous standards established by the FDA with respect to identity, strength, quality, purity and potency.  Generic medications can be substituted for a brand name medications at the time of filling if the generic equivalent as an “AA” or “AB” rating from the US Food and Drug Administration.

10.    Medications with Quantity Limits

Quantity limits are used to manage the quantity of medications available to any member that may be potentially harmful, subject to abuse, is not consistent with the standard of care in today’s medical practice, or other reasons.  Certain lifestyle medications (such as Viagra, Cialis) are subject to quantity limits or other medications that could potentially be harmful if certain dosages are exceeded. Members may obtain prior authorization to obtain such medications at the higher than normal dosage where medically necessary.

11.    Orchard Mail Order Form  

Use this form to submit prescriptions that have been written by your physician.

12.   Orchard Fax Order Form 

Use this form to have your physician’s office fax your prescription to Orchard.  The top portion should be completed by the member; the bottom portion should be completed by the physician.

13.    Medication Alerts 

EnVisionRx Options posts important medication alerts to their website which members may wish to review.  Alerts can be issued by EnVisionRx Options, the Food and Drug Administration, or a drug manufacturer.

14.   General Information about HIPAA

The HIPAA Privacy Regulations place limitations upon covered entities' use of "protected health information" (PHI). Protected health information is information that is individually identifiable and that relates to an individual's past, present, or future medical condition or treatment. The Privacy Regulations also create or formalize several rights members in a health plan have regarding their health information.