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Physicians Plus Insurance Corporation



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Prescriber Resources

Drug Prior Authorization Forms
Apomorphine (Apokyn)
Becaplermin (Regranex)
Eltrombopag (Promacta)
Febuxostat (Uloric)
Growth Hormone - Initiation
Growth Hormone - Continuation
Lidoderm Patch
Methylnaltrexone (Relistor)
Pregabalin (Lyrica)
Ramipril (Altace)
Romiplostim (Nplate)
Teriparatide (Forteo)
Testosterone Replacement
Tetrabenazine (Xenazine)
TNF Inhibitor

All Other Prior Authorization Requests:

Medication PA Request Form



Generic Sampling Program
Members can receive their first one month supply of select generic prescriptions at no charge with the Generic Sampling Program. Remember to prescribe from this list of generic drugs to help members take advantage of this program.

Tablet Splitting Program
Members can save up to 50% on out-of-pocket costs for some of their medications using the Physicians Plus Tablet Splitting Program.

Download and print the one-page instruction sheet showing your patient how to use a tablet splitter.

Maintenance Drug List
Members may obtain select medications, including contraceptives at a three months supply (90 days) for three copays with a prescription from their health care provider.

Flyers

Plus Pearls (Updated June 2009)
ePocrates Overview
Loratadine OTC
Prilosec OTC


Contact Pharmacy Services

Telephone:
608-282-8900 ext. 7803

Fax Number:
608-258-1905

E-mail: pharmacyinfo@pplusic.com

Mailing Address:
Physicians Plus Insurance Corporation
Attn: Pharmacy Services
P.O. Box 2078
Madison, Wisconsin 53701-2078