Pharmacy
SilverSummit Healthplan is committed to providing appropriate, high-quality, and cost-effective drug therapy to all SilverSummit Healthplan members. SilverSummit Healthplan covers prescription medications and certain over-the-counter medications with a written order from a SilverSummit Healthplan provider. The pharmacy program does not cover all medications. Some medications may require prior authorization and some may have limitations. Other medically necessary pharmacy services are covered as well.
Effective January 1, 2026, Nevada Medicaid will implement a Single Preferred Drug List (sPDL). SilverSummit Healthplan will align with this list and follow all prior authorization (PA) criteria and utilization edits formedications included on the sPDL.
Continuity of Care: There will be a 6-month transition period for existing SilverSummit Healthplan members. Current drug therapies that are non-preferred or not on the sPDL will continue to be covered through June 30, 2026.
New Starts: All new medication therapies initiated on or after January 1, 2026 must comply with the sPDL.
Prior Authorization Criteria: For details, please visit: Nevada Medicaid MSM Chapter 1200.
Drug Look-up Tool
Prior Auth Forms
Please use the search function or select View All to locate the drug specific SilverSummit Healthplan prior authorization form that should be used when submitting an authorization request.
Electronic Prior Authorization Submissions
Electronic Prior Authorization Submissions
Submit your prior authorization (PA) requests electronically through our preferred solution CoverMyMeds. Electronic prior authorization (ePA) automates the PA process making it a quick and simple way to complete PA requests. The ePA process is HIPAA compliant and enables faster determinations. You may also use this link to track ePA requests.
SilverSummit Healthplan's PBM, processes pharmacy claims and administers the medication prior authorization process.
Prior Authorization Fax: 1-866-399-0929
Clinical Hours: Monday – Friday 10 a.m. - 8 p.m. (EST)
The Maintenance Drug Program provides details of the products that can be dispensed as part of this benefit.
Members can also obtain a 100 day supply (3 month supply) of their maintenance medications from participating retail maintenance drug pharmacies.
To find a pharmacy that is in the SilverSummit Healthplan network, you can use the Find a Provider tool.
AcariaHealth, SilverSummit Healthplan's preferred specialty pharmacy vendor, can supply a number of products. Some of these products can be delivered directly to the provider’s location for office administration by SilverSummit Healthplan's preferred specially pharmacy provider, AcariaHealth.
AcariaHealth - https://acariahealth.envolvehealth.com
Phone: 1-800-511-5144
Prior Authorization Request Form For Specialty Prescription Medications (PDF)