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Elixir pharmacy staff are available 24 hours a day at 1-844-222-5584
Prior Authorizations
Prior authorization forms are appropriate for both Commercial and Medicaid lines and must be completed by the prescribing physician.
Medications
Please check the formularies listed below to see if a medication requires prior authorization. A medication marked with “PA“ will require a prior authorization. If you cannot locate your medication in the formulary, please contact us.
- Pharmacy Prior Authorization Form
- Qualified Health Plan Authorization Form
- Medical Drug Prior Authorization Form
Specialty Drugs
Total Health Care works with Diplomat Specialty Pharmacy to provide Specialty Drugs to our members. A list of specialty drugs requiring prior authorization are listed in the document below.
Elixir pharmacy staff are available 24 hours a day at 1-844-222-5584
Formularies – Updated as of 09/02/2021
A formulary is a list of guidelines for coverage of drugs and other products through Total Health Care.
Commercial
- 2-Tier Commercial Approved Drug List
- 3-Tier Commercial Approved Drug List
- 4-Tier Commercial Approved Drug List
- 4-Tier Commercial High Deductible Health Plan Approved Drug List
- 4-Tier Commercial High Deductible Health Plan Chronic Condition Enhanced Prescription Drug List
- 2-Tier Alternative List ofr Non-covered Drugs
- 2-Tier Search By Drug Name
- 3-Tier Search By Drug Name
- 4-Tier Search By Drug Name
- 4-Tier High Deductible Health Plan Search by Drug Name
Qualified Health Plan – Includes healthcare.gov, Individuals & Families, and SHOP
Healthy Michigan Plan
Note: Effective 7/01/2016, THC has transitioned to Michigan’s Common Drug Formulary. For further information, click here
- Healthy Michigan Plan Approved Drug List
- Healthy Michigan Search By Drug Name
- Healthy Michigan Alternative List for Non-covered Drugs
Medicaid
Note: Effective 7/01/2016, THC has transitioned to Michigan’s Common Drug Formulary. For further information, click here
- Medicaid Approved Drug List
- Medicaid Alternative List for Non-covered Drugs
- Medicaid Children’s Special Health Care Services (CSHCS) Approved Drug List
- Medicaid Search By Drug Name
Approved Drug List Changes
Electronic Prescribing
Make the switch from handwritten to electronic prescriptions here. You will save time, money and improve patient safety.