Click here to view your health plan’s preferred drug list (PDL) of covered medications.
Your health plan covers a 90-day supply of medication through local Walgreens pharmacies. If you would like to participate:
Your provider should write your prescription for a 90-day supply with three refills when appropriate (not a 30-day supply) and submit a request for home delivery.
Mail order benefits are only available to group health plan members. If you’re an individual health plan member, your local retail pharmacies can fill your prescriptions for up to 30 days at a time. This doesn’t affect any high-cost specialty drugs you may receive through the mail from BriovaRx.
Your provider can submit a prior authorization request online, by fax or mail.
CoverMyMeds assists providers with electronically submitting prior authorization requests to insurance companies. CoverMyMeds is NOT affiliated with Health Plan of Nevada. If you received communication from CoverMyMeds, you will need to contact CoverMyMeds directly.
You, your authorized representative, or your provider acting on your behalf and with your written consent may file an appeal either orally or in writing. A written, signed appeal request must follow an oral filing. Mail or deliver your written appeal to Sierra Health and Life, 2720 North Tenaya Way, P.O. Box 14865, NV017-3020, Las Vegas, NV 89114-4865.
You, your authorized representative, or your provider acting in your behalf may file an appeal either orally or in writing. Fax your appeal to 702-266-8813 or call Member Services toll-free at 1-800-962-8074, TTY 711. Weekdays after 5 p.m., weekend or holidays, call Customer Response and Resolution toll-free at 1-800-578-6757, TTY 711. Sierra Health and Life’s Pharmacy Services team does not process appeals.
We may offer a vacation override. A vacation override allows you to obtain medication in advance for extended vacations as outlined below whether it is within the U.S. or outside the country. Vacation overrides may be granted up to a 30-day supply for up to two vacations per year. If the date of your vacation changes, then a flight itinerary may be required. To request a vacation override, please call Member Services toll-free at 1-800-962-8074, TTY 711. You will need to provide the dates of your travel and the names of the prescription drugs you are requesting to be filled. Overrides may take up to 24 hours to process and entered for up to three days prior to their departure.
Please contact your pharmacist directly to request medication synchronization.
Members can contact us toll-free at 1-800-777-1840, TTY 711, Monday through Friday, 8 a.m. to 5 p.m.
Drugs covered under your pharmacy benefit tend to be oral medications/devices or injections that can be self-administered under the skin or into the muscle. A claim for payment is submitted to the health plan by the pharmacy. You, the member, is responsible for the copay for the drug only. The copay amount can vary by the tier level the drug is placed on by your health plan. Drugs covered under your medical benefit tend to be medications that require provider administration, are used to make a diagnosis or used during a procedure. A claim for payment is submitted to the health plan by the provider. The member is responsible for a copay for the office visit and coinsurance for the drug product. Coinsurance is the percentage of the drug cost that you pay after you have paid your deductible.
If the pharmacy is having trouble submitting claims, ensure they are entering the following information appropriately: Member’s sex (male/female), member’s date of birth, Bank Identification Number (BIN) (a six-digit number on your health insurance card that tells the computer database at the pharmacy which health insurance provider is to receive the claim for your prescription), Processor Control Number (PCN) (a secondary number on your health insurance card that is used to route pharmacy claims to your health insurance provider), and group name.
A specialty drug is a medication created to target and treat complex medical conditions and rare diseases. These medications are often very expensive and require special handling. They can be taken by mouth, injected, inhaled or infused. Specialty drugs are designated on your plan’s drug list with the abbreviation “SP”. Your health plan requires specialty drugs to be filled at Optum Specialty Pharmacy (formerly BriovaRx) that offers additional support to help members with their specialty prescription products. Coverage of specialty medications are limited to a 30-day supply.
No, over-the-counter products are not covered by Health Plan of Nevada. The “limitations” and “exclusions” sections of your plan pharmacy documents exclude coverage of over-the-counter products.
When it comes to generic and brand name drugs, the main difference is the name and appearance. The U.S. Food and Drug Administration (FDA) requires generic drugs to have the same active ingredient, strength, dosage form, and route of administration as the brand-name drug. They are also developed and approved according to the same standards as brand name drugs ensuring both versions are identical in quality.
Please call Member Services toll-free at 1-800-777-1840, TTY 711. They can assist you with finding a new healthcare provider or see our list of providers.
Please call Member Services toll-free at 1-800-777-1840, TTY 711. They can assist you with finding a lower cost alternative or view our prescription drugs lists. For your convenience, medications are grouped together based on their therapeutic category (i.e., anti-infectives, cardiovascular, etc.) and further separated into drug classes (i.e., antidepressants, contraceptives, etc.). To find a lower cost alternative, look for drugs in the same therapeutic category and drug class that are listed on the PDL at a lower tier level.
There are several reasons why your health plan approves a different quantity than what was prescribed by your doctor. A few of the most common reasons are:
For some drugs, your doctor or other prescriber must get approval from us before you fill your prescription. If you don’t get approval, we may not cover the drug. In order to request approval of a drug, your doctor must fill out the prior authorization form and fax it to Pharmacy Services at 1-800-997-9672. Coverage of certain drugs may require chart note documentation of diagnoses, previously tried medications, or specific lab values for example. If this information is not provided by your doctor, we may request more information from your provider. This process may take up to seven days. You, as the member, do not have to do anything. If you have any questions on the status of the prior authorization request, call Member Services toll-free at 1-800-777-1840, TTY 711.
There are several reasons your drug may have been denied even though your doctor submitted a prior authorization. Here are some of the most common reasons:
When both you and your health insurance company pay for your health care expenses, it’s called cost-sharing. Deductibles, coinsurance and copays are all examples of cost-sharing.
If you need assistance determining your plan’s deductible, coinsurance and copays, call Member Services toll-free at 1-800-777-1840, TTY 711, or sign in to the online member center.