Prior Authorization Drug Guidelines

High Level Drug Policies

Preferred Specialty Management Policies

Express Scripts Drug Policies

Adopted Express Scripts QLL Policies

Due to proprietary reasons, we are unable to post the Milliman Care Guidelines on our website, but a hard copy of an individual guideline can be provided as requested.

Milliman Care Guidelines (MCG) but not limited to:

  • Abraxane
  • Alferon
  • Antagon
  • Aredia
  • Avastin
  • Cayston
  • Cerezyme
  • Docetaxel
  • Elaprase
  • Euflexxa
  • Eylea
  • Gammagard
  • Gamunex C
  • Gattex
  • Gemcitabine
  • Infergen
  • Intron
  • Laronidase
  • Macugen
  • Myobloc
  • Neulasta
  • Octreotide Acetate
  • Orthovisc
  • Provenge
  • Pulmozyme
  • Soliris
  • Somavert
  • Synagis
  • Treprostinil
  • Ventavis
  • Vpriv
  • Xgeva
  • Xiaflex
  • Yervoy


VCHCP Custom Drug Policies:

Market Events Program:

Market Events Program Policy For Exception Review of Excluded Drugs

National Preferred Formulary Exclusions List

National Preferred Formulary Exception Criteria for Exception Review Only

Formulary Exclusions -For Exception Review Use Only:


Step Therapy

Medication-Related Policies

VCHCP Custom Drug Policies – Medical Benefit

                                                                                            Ventura County Health Care Plan (VCHCP)
                                                                                            2220 E Gonzales Road, Ste 210B Oxnard, CA 93036

                                                                                            Regular business hours are:
                                                                                            Monday - Friday, 8:30am to 4:30pm