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 recieve by reviewing the materials available to both commercial and Medicare members.

Medicare Pharmacy Information
Commerical Pharmacy Information

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 website, or you can contact our pharmacy department to have a copy mailed to you.

Network Health manages commercial, exchange and Medicare formularies. All are 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 managers, Express Scripts, Inc. (ESI) and CVS/caremark™. For the exchange, these rules are created and reviewed independently through CVS/caremark’s pharmacy and therapeutics committee and are administered through our pharmacy benefits manager CVS/caremark.

ESI administers prescription benefits for our Medicare members, 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 Medicare members.

CVS/caremark administers prescription benefits for all of our commercial and exchange members, including the review of our utilization management rules and maintaining the pharmacy network. CVS/caremark is the designated contact for all clinical medication reviews, exceptions and authorizations, regardless of the drug or pharmacy. In addition, CVS/caremark offers mail services for all commercial groups, most self-insured plans and individual and family plan members. Mail order for Network Health self-insured participants is handled through Ascension WI Retail Pharmacy Wausau.

Preferred Drugs and Authorizations

Standard Preferred Drug List
Prior Authorization Drug List
Authorization List for Step Therapy Drugs

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

Pharmacy Contact Information by Plan Type

 

Medicare – Express Scripts

Prior Authorization Requests
CoverMyMeds 
ExpressPath 

Phone:  866-544-6962
Fax:      877-251-5896
Email:   medicarepartdparequest@express-scripts.com

 




Express Scripts Customer Service
800-316-3107

Mail order prescriptions can be sent to ESI by mail or fax.
Fax: 800-636-9494

Mail to:
ESI Mail Order
P.O. Box 66568
St. Louis, MO 63166-6568


Commercial Lines of Business - CVS/caremark

CVS/caremark must be used for commercial group, self-insured groups and individual and family members requiring specialty products. When using CVS/caremark for specialty products that require prior authorization, contact CVS/caremark’s prior authorization center to review the clinical criteria.

 

Prior Authorization Requests
CoverMyMeds 
Surescripts 
  

Phone:  855-839-5206
Fax:     888-836-0730 (takes two business days)
Mail to:
CVS Caremark
ATTN: PA Dept
1300 E. Campbell Rd.
Richardson, TX 75081        

CVS/caremark Customer Service
855-282-8476

CVS/caremark Mail Service
(For commercial group, most self-insured groups and individual and family plans)
Phone: 800-378-5697
Fax: 800-378-0323

Caremark Specialty Pharmacy
Phone:
800-237-2767
Fax: 800-230-5548


Health Insurance Exchange (HIX) - CVS/caremark

Prior Authorization Requests
CoverMyMeds 
Surescripts   

Phone: 855-582-2022
Fax:     855-245-2134 (takes two business days)
Mail to:
CVS Caremark
ATTN: PA Dept
1300 E. Campbell Rd.
Richardson, TX 75081  




CVS/caremark Customer Service - HIX

855-801-8184

CVS/caremark Mail Service
Phone:
 800-378-5697
Fax:      800-378-0323

CVS/caremark Specialty Pharmacy
Phone:
800-237-2767
Fax:      800-230-5548


Network Health Self-Insured

Ascension WI Retail Pharmacy Wausau must be used for Network Health Plan self-funded participants requiring mail order. If the medication requires a prior authorization, contact CVS/caremark’s prior authorization center to review the clinical criteria.

Ascension WI Retail Pharmacy Wausau
Phone:  
715-355-9573
Fax:       715-355-9579
Mail to:
1901 Westwood Center Blvd
Wausau, WI 54401


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