Prescribers

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

Here you can quickly access coverage determination links, forms, and other helpful information.

The Elixir Pharmacy and Therapeutics (P & T) Committee is a multidisciplinary team of physicians, pharmacists, and other health care professionals that provides clinical oversight of the drug utilization management process. This information is available to prescribers upon request.

For any questions, please contact us.

Coverage Determination Links

Coverage Determination Forms – Search By Drug

Coverage Determination Forms

Covered Drug Lists

The following are lists of the most commonly prescribed brand medications. They represent an abbreviated version of the drug list (formulary) that is at the core of each prescription-drug benefit plan. These lists are not all-inclusive and do not guarantee coverage. In addition to drugs on these lists, the majority of generic medications are covered and members are encouraged to ask their doctor to prescribe generic drugs whenever appropriate.

The Elixir Pharmacy and Therapeutics Committee is responsible for the development and maintenance of the Formularies. The Committee is comprised of independent practicing physicians and pharmacists from a wide variety of medical specialties. The formularies are reviewed and updated as new drugs or new prescribing information becomes available.

Factors which affect decisions regarding the formulary include safe use, clinical efficacy, and therapeutic need. Cost is considered only after all other factors are assessed. Compliance with the formulary is important for improving quality of care and restraining health care costs. As a component of formulary compliance, preferred brand drugs may be moved to non-preferred status if a generic version becomes available during the year. Any medication approved to enter the market will not be covered until reviewed by the Elixir Pharmacy and Therapeutics Committee. These lists may be subject to change and not all drugs listed are covered by all prescription-drug benefit programs.

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.

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.