Pharmacy
Vaya Health offers pharmacy benefits for Medicaid members of Vaya Total Care, our Behavioral Health and Intellectual/ Developmental Disabilities Tailored Plan.
Our delegated pharmacy benefit manager, Navitus Health Solutions, administers this benefit on Vaya’s behalf. Navitus makes authorization decisions for medication requests based on medical necessity guidelines and other statutory and regulatory standards. If you have questions about pharmacy prior authorization or medication coverage for Vaya Total Care Medicaid members, please call our Pharmacy Service Line at 1-800-540-6083.
Vaya has adopted the NC Medicaid Preferred Drug List (PDL). Generic medications must be dispensed when available and on the PDL. To request exceptions to the PDL (or any medication-specific limits) with member-specific clinical justification, call the Pharmacy Service Line at 1-800-540-6083 or complete the Standard Drug Request Form available on our Pharmacy Prior Authorization and Forms page.
Pharmacy and Prescriber Resources
- Pharmacy Provider Portal
- Pharmacy Prior Authorization and Forms page
- Medication Search
- NC Medicaid Physician Administered Drug Program (PADP)
- NC Department of Health and Human Services Clinical Coverage Policies (Pharmacy)
- Navitus Pharmacy Provider Manual
- Vaya Health Provider Operations Manual
Vaya Health Lock-In Program
Vaya encourages the safe prescribing, dispensing, and use of controlled substances, including opioids and benzodiazepines. The Vaya Health Lock-in Program helps people with harm reduction behaviors to improve quality of care, increase safety, and reduce inappropriate service utilization.
Members identified as overutilizing drugs in these therapeutic classes may be placed in the Lock-In Program and restricted to receiving opioid and benzodiazepine prescriptions from up to two providers (e.g., pain management and behavioral health) and from one pharmacy. Claims submitted by other prescribers or other pharmacies will not be paid.
Providers or pharmacies may request exceptions, subject to limits, for emergency situations by calling the Pharmacy Service Line at 1-800-540-6083.
For more information about the Lock-In Program, visit our Pharmacy Lock-in Program page for Vaya members.