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.
Preferred Drug List (PDL)
Preferred Drug List
Prior Auth Criteria Search
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.
Envolve Pharmacy Solutions, 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)
SilverSummit Healthplan provides members with 100 day supplies through participating retail maintenance drug pharmacies. 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.