This section is to assist you with exceptions and prior authorizations for Sierra VillageHealth (HMO).

What is an exception request?  This type of request allows members to ask for a determination or redetermination of coverage for an exception of a nonformulary drug, a non-preferred drug at a preferred cost, or step therapy.  A doctor must submit a statement supporting your exception request, which should be submitted with your exception request either with the Exception Request Form or a separate request.  An exception may also include a request to waive coverage restrictions or limits, for example a quantity limit. To request an exception, use the Exception Request Form.  Please make sure to complete all requested information and submit the form as outlined below.

To submit an exception request by fax, fax to 702-341-7566 or 1-877-219-1612. Hours of operation are 8 a.m. - 8 p.m., 5 days a week.

To submit an exception request by mail , mail to HPN - Pharmacy Services, Attn:  Medical Necessity, P.O. Box 15645, Las Vegas, NV 89114-5645.

What is a request for prior authorization?  This type of request is a process by which a drug must be approved (prior authorized) for coverage before Sierra VillageHealth will pay for it.  To request a prior authorization, please have your provider complete and submit a Prior Authorization Form.  If you request the prior authorization directly, Sierra VillageHealth must allow your provider to have a minimum of 96 hours for a standard determination and 48 hours for an expedited determination to provide supporting documentation.  To review prior authorization criteria, click on the button to your left. 

To submit a prior authorization request by phone, call 702-242-7050 or 1-800-443-8197; TTY: 1-866-789-1530.  Hours of operation are 8 a.m. - 8 p.m., 5 days a week.

To submit a prior authorization request by fax, fax 702-341-7566 or 1-877-219-1612.  Hours of operation are 8 a.m. - 8 p.m., 5 days a week.

To submit a prior authorization request by mail , mail to HPN - Pharmacy Services, Attn:  Medical Necessity, P.O. Box 15645, Las Vegas, NV 89114-5645.

You can also review your Evidence of Coverage for more information.  To access your Evidence of Coverage from this Web site, click here .

If you have questions, need assistance filling out a form, or would like to inquire about the status of an exception or prior authorization request, you or your provider may call Sierra VillageHealth at 1-866-421-4386 ; TTY:  1-866-525-7833.  Hours of operation are 8 a.m. - 8 p.m., 5 days a week.