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.
Contact our Pharmacy Department
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.
Prior authorizations by fax:
Retail prior authorization:
Medical injectables:
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
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.
Hot Tips:
Pharmacy Hot Tips are brief messages that provide information on preferred formulary products used to treat common diseases and conditions such as asthma and diabetes.
If you would like additional pharmacy information to assist our members, contact your Provider Relations representative, and we will prepare a pharmacy Hot Tip for you!
Documents
- Hot Tip: Acne
- Hot Tip: ADHD
- Hot Tip: Allergies
- Hot Tip: Asthma (Adults)
- Hot Tip: Asthma (Pediatric)
- Hot Tip: Atypical Antipsychotics
- Hot Tip: Chronic Pain
- Hot Tip: Diabetes
- Hot Tip: Opioid Use Disorder
- Hot Tip: Proton Pump Inhibitors (Adult)
- Hot Tip: Proton Pump Inhibitors (Pediatric)
- Hot Tip: Topical Corticosteroids
Related information
Documents
Formulary resources
Related pages
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub
- Learn about Availity
- Prior Authorization lookup tool
- Prior Authorization requirements
- Claims overview
- Member eligibility & pharmacy overview
- Provider manual and guides
- Referrals
- Forms
- Training Academy
- Pharmacy information
- Electronic Data Interchange (EDI)
Interested in becoming a provider in our network?
We look forward to working with you to provide quality services to our members.
Join Our Network