Effective July 1, 2025, Sentara Health Plans Pharmacy Department has partnered with Surescripts to allow providers the option of utilizing Electronic Prior Authorization to initiate a prior auth request. Providers can submit requests directly through their Electronic Health Record (EHR) systems or through Surescripts online portal.
Pharmacy Step Therapy Exception Requests
Certain prescription drugs may be subject to step therapy requirements. When medically appropriate, providers or members may request an exception to a step therapy requirement through Sentara Health Plans' existing pharmacy prior authorization process. The process is available through the pharmacy authorization resources on this page.
- The step therapy-required medication is contraindicated for the member.
- The required medication is expected to be ineffective based on the member's medical history.
- The member previously used the required medication and discontinued therapy due to lack of effectiveness or adverse effects.
- The member is currently stable and achieving a positive therapeutic outcome on the requested medication.
Providers may submit requests electronically or by using the applicable pharmacy authorization forms available on this page. Requests should include supporting clinical documentation necessary for review. Requests are evaluated using applicable plan criteria, clinical information, claims history, and supporting documentation submitted by the prescriber.