Pharmacies

Welcome to the Pharmacy Provider Portal. We’re dedicated to bringing you the information you need to best care for your patients.

Here you can quickly access processing information, pharmacy enrollment requests, electronic pay information, MAC disputes and more.

The Annual Pharmacy Attestation can be found here.

For additional questions, please call our Pharmacy Help Desk at 800-361-4542 or contact us.

Processing Information

Enrollment for Independent Pharmacies

How to become a Participating Pharmacy in the Elixir Network:


  1. Ensure Part I and II of your pharmacy’s NCPDP profile is up-to-date with the most current information.
  2. Complete all fields on the Pharmacy Network Enrollment Request form and return to Provider Relations via email providerenrollment@elixirsolutions.com.
    • Pharmacy Network Enrollment Request forms that are not signed will not be processed.
  3. Once the completed Pharmacy Network Enrollment Request form is received, Provider Relations will review in addition to Part I and II your pharmacy’s NCPDP profile for credentialing.
    • Please note, completion of the Pharmacy Network Enrollment Request form and NCPDP Part I and II does not guarantee access into the Elixir Network.
  4. You will receive an email response back stating whether your pharmacy has passed credentialing or not.
  5. If your pharmacy passes credentialing, you will be sent a Participating Provider Agreement (PPA) for signature.
  6. Once Provider Relations has received the signed PPA from your pharmacy, please allow 7-10 business days before you are able to process claims.

For all other inquiries, please contact the Elixir Pharmacy Help Desk toll-free at 800-361-4542.

Electronic Payment & Remittance

We are happy to provide our participating pharmacies with the opportunity to receive payment electronically via ACH and remittance details electronically in HIPAA 835 format.

You must submit all forms in order for your request to be processed! Please contact us at PharmacyPayables@elixirsolutions.com with any questions.

MAC

MAC pricing is available to pharmacies upon request via calling the help desk at 800-361-4542 or emailing MACdisputes@elixirsolutions.com.

Pharmacies may contact us with MAC concerns at MACdisputes@elixirsolutions.com or through the Elixir Pharmacy Help Desk at 800-361-4542. Appeals will be responded to within seven business days.

Pharmacies are requested to provide the following to ensure that requests can be reviewed without any disruption:

  • RxBIN
  • GroupID
  • Rx number
  • Date of fill
  • NDC
  • Drug and strength
  • Quantity dispensed
  • NCPDP number
  • Acquisition cost
  • Contact name and number

Pharmacy Satisfaction Survey

Please take a minute to complete our Pharmacy Satisfaction Survey. Your responses will be kept confidential. It is through your honest feedback that we can improve our services to you. It will only take a few minutes to complete.

Utilization Management Statement

  • Utilization Management decision making is based only on appropriateness of care and service and existence of coverage.
  • The organization does not specifically reward practitioners or other individuals for issuing denials of coverage.
  • Financial incentives for Utilization Management decision makers do not encourage decisions that result in underutilization.

Health Information & Resources

  • Professional comment form
  • Adverse drug reporting
  • Health & drug information
  • Pharmaceutical Management Procedures
    • Contact us if you have any questions regarding:
      • How to request the utilization management criteria
        • If you would like to obtain a copy of the UM criteria or additional information on how coverage determinations are made please call 800-361-4542 and our customer care team will be happy to assist you.
        • Criteria forms are also available for download from our website: Criteria Forms
      • Covered medications, including restrictions and preferences
        • For more information on covered medications or formulary updates please see the current year “Covered Drug Lists” Covered Drug Lists
      • Copayment information, including tiers
        • For more information about medication copays and formulary tiers, please call 800-361-4542 and our customer care team will be happy to assist you.
      • Medications that require prior authorization
        • Prior authorization medications require the plan’s approval before the medication will be covered.
        • If the prescribed medication requires a Prior Authorization, you can request a "Coverage Determination Request” asking the plan to review the request to approve coverage of the medication.
          • To Submit a Prior Authorization Request:
            • Coverage Determination Links
            • Click “Online Coverage Determination (PromptPA)
            • You will be directed to the PromptPA Web Portal (PromptPA)
            • Within the Portal, select the "Prescriber" link to begin
            • Fill out each screen within the portal as prompted and click "Next"
            • When you get to the last screen, click "Finalize"
            • Your request will be sent to Elixir for review
      • How to initiate the exception process
        • If the member’s medication is not covered or they require an exception to the formulary medication, an "Exception Request" (request to cover the medication) can be made to ask the plan for a review to cover the medication.
          • To Submit an Exception Request:
            • Coverage Determination Links
            • Click “Online Coverage Determination (PromptPA)
            • You will be directed to the PromptPA Web Portal (PromptPA)
            • Within the Portal, select the "Prescriber" link to begin
            • Fill out each screen within the portal as prompted and click "Next"
            • When you get to the last screen, click "Finalize"
            • Your request will be sent to Elixir for review
      • Limits on refills, doses or prescriptions
        • Certain covered drugs require a Quantity Limit restriction. This means we may only cover the drug up to a determined quantity or amount. You can request a quantity limit exception for the member if you feel it is medically necessary to exceed these limits. The quantity limit exception requires approval before the higher quantity will be covered. Quantity Limits are generally used as a safety precaution to prevent certain prescription drugs from being over-utilized.
        • Limited Access refers to prescriptions that may only be available at certain pharmacies. For more information call Customer Care at 800-361-4542.
      • Use of generic substitution, therapeutic interchange or step-therapy protocols
        • We do not automatically issue generic substitutions or therapeutic interchange, although brand name drugs may not be on the formulary and may require an exception.
        • Certain covered drugs require step-therapy. Step therapy is a requirement that encourages the member to try less costly but just as effective drugs before the plan covers another drug. For example, if Drug A and Drug B treat the same medical condition the plan may require you to try Drug A first. If Drug A does not work for the member, the plan will then cover Drug B.
      • Any other questions regarding pharmaceutical management procedures
        • If there are questions regarding how to use our pharmaceutical management procedures or the content within please call 800-361-4542 and our customer care team will be happy to assist you.