Pharmacy information

Wellpoint will administer pharmacy benefits for enrolled members. CarelonRx* is the pharmacy benefits manager.

Medicaid

Please refer to the Preferred Drug List (PDL) when prescribing for our members. This guide does not contain a complete list of drugs; rather, it lists the preferred drugs within the most commonly prescribed therapeutic categories.

Though most medications on the PDL are covered without prior authorization, a few agents will require you to contact our Pharmacy Department for authorization.

Prior Authorization Requests

Some drugs, drug combinations, and drug doses require prior authorization (PA). To submit electronic prior authorization (ePA) requests, use CoverMyMeds. Creating an account is free.

While ePA helps streamline the PA process, you may also initiate a new PA request by calling or faxing a completed Pharmacy Prior Authorization form to Wellpoint using the contact information and forms on this page.

Wellpoint Pharmacy Prior Authorization Center

For prior authorizations, including step therapy exception requests, please submit your request by phone or fax using the following contact methods.

Pharmacy Department:

1-833-731-2149

Available 8:00 a.m. to 8:00 p.m. EST Monday through Friday;
10:00 a.m. to 2:00 p.m. EST on Saturday.

Retail prior authorization by fax:

1-844-509-9863

Medical injectables prior authorization by fax:

1-844-509-9865

Medicare

Please refer to the formulary when prescribing for Medicare members. Though most medications on the formulary are covered without prior authorization, a few agents will require you to obtain an authorization.

For Medicare Part B, contact:

Provider Services

1-866-805-4589 (Select option 5)
8:00 a.m. – 8:00 p.m. local time; Monday to Friday

For Medicare Part D, contact:

CarelonRx Provider Services

1-833-293-0659

Medicare Part D Rx coverage determinations and appeals

Providers can send a request for a prescription coverage determination for a Medicare plan via electronic prior authorization (ePA) rather than fax or phone by submitting the request from CoverMyMeds or SureScripts.

CoverMyMeds

SureScripts