PBH Outpatient Prescription and Laboratory Policies
Published: October, 2001
PBH clinicians with prescriptive authority should remember:
PBH benefit plans do not cover medications. PBH is not
responsible for determining which medications will be covered
under a specific formulary.
For PBH members who also have PacifiCare medical insurance,
providers may receive a fax copy of the PacifiCare Health
Systems outpatient drug formulary by calling (800) 711-4555,
entering the formulary catalog #1550 and their fax number.
The list will be faxed immediately. For prior authorization,
call the Prescription Solutions medical provider line at
(800) 711-4555.
Laboratory tests for medications may require coordination
with the primary care physician or medical group.
PBH recommends that providers work with members to review
the procedure for coverage of medications and laboratory
services under their medical plan.
PBH providers can contact the Provider Helpline at (800)
716-1166 for assistance with medication and laboratory service
issues.
