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Provider Resources

Pharmacy Information

Member Benefits

With a Network Health plan, our members receive access to pharmacy benefits and a number of online tools, such as Find a Pharmacy and Look Up Medications. Learn more about the pharmacy benefits members receive by reviewing the materials available to both commercial and Medicare members.

Individual Medicare Pharmacy Information
Group Medicare Pharmacy Information
Commercial Pharmacy Information
Individual and Family Pharmacy Information

Pharmacy Network Update

Express Scripts (ESI) is the pharmacy benefits manager for all Network Health lines of business. 

Provider Notification
Find important references and information to help you navigate our prescription drug plan formularies.

Formulary Overview

You will find our online formularies via the Look Up Medications tool. If you would like a printed copy of the formularies, you may print the PDF documents directly from the tool, or you can contact our pharmacy department to have a copy mailed to you.

Network Health manages commercial and Medicare formularies. ESI manages the exchange formulary. All formularies very similar with slight differences found within tier structures, drug tier placements, utilization management rules and other requirements or restrictions. Some of our utilization management strategies include prior authorization, step therapy protocols, quantity level limits and specialty drug restrictions. For commercial and Medicare, these rules are created and reviewed independently through our pharmacy and therapeutics committee and are administered through our pharmacy benefits manager, ESI. For exchange, these rules are created and reviewed through ESI's pharmacy and therapeutics committee and administered by ESI.

ESI administers prescription benefits for commercial, exchange and Medicare plans, including the review of our utilization management rules and maintaining the pharmacy network. ESI is the designated contact for all clinical medication reviews, exceptions and authorizations, regardless of the drug or pharmacy. In addition, ESI offers mail order services for all members.*

*Mail order for Network Health employee plan participants is handled through Froedtert Home Delivery.

Pharmacy Contact Information by Plan Type

Express Scripts, Inc. - Medicare

Prior Authorization Requests

Phone: 866-544-6962
Fax: 877-251-5896
Email: [email protected]

Express Scripts Customer Service

Medicare Mail order prescriptions can be submitted to ESI by phone, fax or mail.
Phone: 888-468-5539 
Fax: 800-636-9494

Mail to:
Express Scripts
P.O. Box 66577
St. Louis, MO 63166-6577

Express Scripts, Inc. - Health Insurance Exchange

Prior Authorization Requests

Phone: 800-224-1062
Fax: 877-251-5896

Express Scripts Customer Service

Mail order prescriptions can be sent to ESI by phone or fax.
Phone: 888-327-9791
Fax: 800-837-0959 

Express Scripts, Inc. - Commercial

Prior Authorization Requests

Phone: 800-209-0981
Fax: 877-251-5896

Express Scripts Customer Service

Mail order prescriptions can be sent to ESI by phone or fax.
Phone: 888-327-9791
Fax: 800-837-0959 

Network Health Self-Insured

Froedtert Home Delivery must be used only for Network Health employee plan participants who use mail order prescription services. If the medication requires a prior authorization, contact ESI's prior authorization center to review the clinical criteria.

Froedtert Home Delivery and Specialty Pharmacy
Phone:  414-805-5690
Email: [email protected]
Fax: 414-805-6513
Hours: Monday–Friday from 6:30 a.m. to 6:30 p.m. CST
Mail to:
Pharmacy at Froedtert Hospital
8850 William Coffey Drive
Milwaukee, WI 53226


Prior Authorizations

ESI Care Continuum Prior Authorization Drug List for Medicare, Commercial and Health Insurance Exchange
June 2024
July 2024

Care Continuum and Evicore Step Therapy Drug List
January 2024
July 2024

To request a new or existing medication be added to the preferred drug list, please send a letter indicating the significant advantages of current preferred medications to the address below. Factors to consider include effectiveness, side effects, drug interactions and cost.

Network Health
ATTN: Pharmacy Benefits
1570 Midway Pl.
Menasha, WI 54952

Note: For Medicare, all prior authorizations for Part D oncology drugs and medical oncology drugs go through eviCore. For all other lines of business, prior authorizations for all pharmacy and medical oncology drugs go through eviCore.

Drug Exceptions

Network Health and ESI each have a Pharmacy and Therapeutics Committee that determines medication tiering and utilization management criteria based on clinical evidence, safety, cost and national recognized therapeutic guidelines. You can request an exception for a patient and request Network Health to cover a medication that is not covered or partially covered.

Exceptions can be handled both externally and internally. Exceptions usually require a supporting statement explaining why alternative medications are not sufficient.

Common Exception Reasons

  • The requested drug is not on the formulary
  • The requested drug is part of a step therapy
  • A medical condition or drug interaction exists that may require use of the requested drug
  • The requested drug requires a prior authorization

How to Handle a Potential Exception

  • The patient can contact customer service for a list of similar drugs covered by Network Health. 
    • He or she can review this list with the prescriber and discuss alternate medication options. 
    • Network Health formulary drugs are often less expensive and easier to obtain than non-formulary drugs.
  • The prescriber must obtain a prior authorization for the exception. This is necessary to determine medical necessity.
    • The prescriber can complete a prior authorization electronically or via fax and explain why an exception is required. 
    • Electronic requests can be done through portals such as CoverMyMeds® or ExpressPAth®
    • If the prescriber is unable to submit the request electronically, this paper form can be faxed to Express Scripts. 
    • Contact Express Scripts at 800-417-8164 with any questions about this process.  

For Medicare, a decision will be made regarding the exception within three business days of receiving all the necessary information–including the supporting prescriber statement. You can request an expedited decision if you feel the patient's health could be harmed by a three-day waiting period. If your expedited request is granted, a decision will be provided within 24 hours of receiving the supporting prescriber statement.

  • If a prior authorization is denied, the member can request an internal review by contacting Network Health. 
    • The customer service representative can help the member request to cover the drug.
    • When requesting, a statement from the prescriber is often necessary to support the request for an exception. 
  • Examples include the below.
    • Request coverage for a drug, even if it is not on our drug list.
    • Ask us to remove coverage restrictions or limits on a drug.
    • If the internal review upholds the denial, the member will receive a written denial which will contain a form that he or she can complete and send back to request an external review by an independent review organization.

ESI Care Continuum (CCUM)

Network Health has partnered with ESI Care Continuum (CCUM) for medical drug prior authorization effective May 1, 2019. CCUM will handle pre-determination and prior authorization requests for medical drug (excluding oncology drug) for all lines of business, including Medicare, commercial and Health Insurance Exchange. eviCore will continue to review oncology medical drug requests.

Learn more about Care Continuum 

Drug requests can be submitted via the ExpressPAth portal, available 24 hours a day, seven days a week. Providers will have seamless access to ExpressPAth through the Network Health provider portalProviders should use their NPI number, not the facility NPI when submitting requests. 

ESI Care Continuum Registration Portal User Guide
Video Portal Tutorials
ExpressPAth Quick Start Guide

The Script is the bimonthly newsletter produced by the Network Health pharmacy department to inform providers of current and upcoming pharmacy-related news.

Statin Toolkit

We've created informational pieces that you may find helpful.

Statin Myths - Providers
Statin Myths - Member Handout - English
Statin Myths - Member Handout - Arabic
Statin Myths - Member Handout - Hmong
Statin Myths - Member Handout - Spanish

SUPD ICD-10 Exclusions

Safe Use of Opioid Pain Medication

The Center for Medicare and Medicaid Services (CMS) has published guidance to help prescribers and pharmacists diagnose opioid medications according to new Medicare drug policies.

Medicare Part D Opioid Policies: Information for Pharmacies

Medicare Part D Opioid Policies: Information for Prescribers

Medication Recalls

This section contains information about manufacturer medication recalls.

Network Health
1570 Midway Place
Menasha, WI 54952
Mon., Wed.-Fri.: 8 a.m. to 5 p.m.
Tuesday: 8 a.m. to 4 p.m.

COVID-19 Information for Network Health Members