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Virginia Premier Elite Plus  

Medicaid WRAP Formulary

If you search for a brand named drug that is not covered, and there is a generic alternative available, that generic alternative will display. Click on the generic alternative for coverage details. If there is no generic alternative, see the details regarding exceptions.


To request a Prior Authorization or Quantity Limit please call EnvisionRx, the Virginia Premier Elite Plus pharmacy benefit manager, at 844-838-0711. Exceptions to the formulary status of a drug cannot be made.


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Questions?   Contact the Virginia Premier Elite Plus Pharmacy Benefit Manager EnvisionRx at 844-838-0711.
Formulary Id: 0001234
Formulary Effective Date: 08/01/2019
Updated:
08/2019
CMS Approval Date:
08/01/2017
CMS Version:
1

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