If you have questions about Medicaid medication coverage or prior authorization, please call the Pharmacy Service Line at 1-800-540-6083.
Vaya’s delegated Pharmacy Benefit Manager (PBM), Navitus Health Solutions, reviews and makes decisions for medication requests based on medical necessity guidelines and other statutory and regulatory standards. Navitus offers a Pharmacy Provider Portal for pharmacy utilization management (UM) request submission, but requests may also be submitted via phone (1-800-540-6083), fax (1-855-668-8553), or U.S. mail:
Navitus Health Solutions, LLC
Attn: Prior Authorizations
1025 West Navitus Drive
Appleton, WI 54913
Navitus processes pharmacy UM requests and notifies prescribers of the determination within 24 hours after receipt of the request, except for requests for which the review cannot be completed due to insufficient information. In these cases, Navitus requests the needed information within 24 hours after receipt. Once Navitus receives the additional information, it completes the review within 24 hours.
Vaya allows coverage for a 72-hour supply of medication in emergency situations where the medication could not otherwise be dispensed due to a prior authorization requirement. Vaya does not require a pharmacy to dispense this 72-hour supply if the dispensing pharmacist believes that the prescription presents a risk to the member and if the pharmacist has made good faith efforts to contact the prescriber about it. Vaya covers consecutive 72-hour supplies if the prescriber has not completed the review or if the pharmacist has not been able to contact the prescriber to complete the requested review.
Pharmacy PA Request Forms