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EnvisionRxOptions 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.


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.

EnvisionRxOptions pharmacy staff are available 24 hours a day at 1-844-222-5584

Formularies – Updated as of 09/07/2018

A formulary is a list of guidelines for coverage of drugs and other products through Total Health Care.

Commercial


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


Medicaid

Note: Effective 7/01/2016, THC has transitioned to Michigan’s Common Drug Formulary. For further information, click here



Approved Drug List Changes