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Prescriber Frequently Asked Questions

We recognize and value prescriber relationships as central to supporting member health. Below is a list of frequently asked questions from prescribers.
For even more information, including formularies and prior authorization forms, log in to the Prescriber Portal.

Where can I find drug prior authorization forms?

Prior authorization forms are easily accessed through the Prescriber Portal. 

How long does a drug prior authorization review take?

All prior authorizations are reviewed within two business days of providers submitting all necessary information. Navitus Prior Authorization Specialists will promptly notify providers of any adverse decisions, and assist with expediting the patient’s therapy to a formulary drug.

How do I request an appeal if the medication I have requested for my patient is denied as "not covered"?

Contact Navitus Customer Care toll-free at 1-844-268-9789 to determine if your patient’s benefit allows for an exception, appeal or grievance option.

Who decides which drugs are included and excluded from the Navitus Formulary?

Decisions on which drugs are included or excluded from the Navitus formulary are made by the Navitus Pharmacy & Therapeutics (P&T) Committee, and are based on each drug’s effectiveness, side-effects, interactions and cost/value. The Committee is comprised of prescribers and pharmacists representing a broad range of clinical practice and expertise. The Committee meets quarterly to review new drugs and drug classes, as well as changes in drug indications.

How can I provide feedback about a communication I have received from the Navitus Clinical Department?

Contact Navitus Customer Care toll-free at 1-844-268-9789.

How do I update my contact information with the National Plan and Provider Enumeration System (NPPES)?

Navitus Health Solutions uses NPPES Database as a primary source of prescriber contact information. A health care provider may submit the change to NPPES via the web (https://nppes.cms.hhs.gov) or by paper. If paper is preferred, the health care provider may download the NPI Application/Update Form (CMS-10114) from the Centers for Medicare & Medicaid Services' forms page (www.cms.hhs.gov/cmsforms) or may call the NPI Enumerator (1-800-465-3203) and request a form.

What should I do to resolve an exclusion?