For assistance outside of regular business hours or holidays, please leave a detailed voicemail or submit a prior authorization form clearly marked "Urgent" or "Expedited."
Contact Pharmacy Services –
Actemra SC (tocilizumab)
Neulasta (Pegfilgrastim) – Medical and Pharmacy Benefit Drug
Ocrevus (ocrelizumab) – Medical and Pharmacy Benefit Drug
Cayston (aztreonam lysine Inhalation Solution)
Radicava (Edaravone) - Medical Benefit Drug
Elelyso (taliglucerase alfa)– Medical Benefit Drug
Taclonex (betamethasone dipropionate 0.064% calcipotriene 0.005%)
Gelclair (Bioadhesive Gel)
Haegarda (C1 Esterase Inhibitor) – PA for Prophylaxis
Vantas Preferred (histrelin) - Medical Benefit Drug – Medical Benefit Drug
Yervoy (ipilimumab) – Medical Benefit Drug
Makena – Medical Benefit Drug
This health plan is underwritten by Physicians Plus Insurance, Inc.