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Medical Policies - Pharmacy

  • Off-Label Drug Use Commercial Pharmacy 12

    PDF, 307 KBLast Updated: 05/13/2025

    PDF, 307 KBLast Updated: 05/13/2025

  • Off-Label Drug Use Medicaid Pharmacy 12

    PDF, 267 KBLast Updated: 10/24/2025

    PDF, 267 KBLast Updated: 10/24/2025

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© Sentara Health Plans 2025, PO Box 66189, Virginia Beach, Virginia 23466

Sentara Health Plans is the trade name for Sentara Health Plans, Sentara Health Insurance Company, Sentara Health Administration, Inc., and Sentara Behavioral Health Services, Inc. Vantage Health Maintenance Organization (HMO) and Point of Service (POS) plans are issued and underwritten by Sentara Health Plans. Medicare products are administered under an agreement with Sentara Health Plans and the Centers for Medicare and Medicaid Services (CMS). Medicaid and Family Access to Medical Insurance Security (FAMIS) products are administered under an agreement with Sentara Health Plans and the Virginia Department of Medical Assistance Services (DMAS). Plus Preferred Provider Organization (PPO) products are issued and underwritten by Sentara Health Insurance Company. The Sentara Employee Assistance Program (EAP) is administered by Sentara Behavioral Health Services, Inc. Large group self-funded health plans and BusinessEDGE® plans are administered but not underwritten by Sentara Health Administration, Inc. Wellness programs are administered by Sentara Health Administration, Inc. All plans have benefit exclusions and limitations, and terms under which the policy or plan may be continued in force or discontinued. For costs and complete details of coverage, please call your broker or review this website for more information. Sentara Health Plans complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.