Prior Authorizations:
CarelonRx
CarelonRx Inc. is an independent company providing pharmacy benefit management services on behalf of Healthy Blue.
View the formulary look-up tool to determine which medications require prior authorization.
You can reach CarelonRx at 844-410-6890 from 8 a.m. to 8 p.m. Eastern time, Monday through Friday, and 10 a.m. to 2 p.m. Eastern time on Saturdays. You can also complete the Universal Prior Authorization Request Form: Medications and fax it to 844-512-9005.
CoverMyMeds®
Prescribers can view real-time status of any pharmacy benefit medication prior authorization request submitted via ePA, phone, or fax by logging into the CoverMyMeds website and entering the member’s information. They can also call CoverMyMeds directly at 866-452-5017 or use the live chat on their website for questions, information or website concerns.
Medical Benefit Specialty Medications
Specialty medications are often covered under the medical benefit. They can be costly for our members, and not all plans cover them the same way. That’s why it’s important to review whether the use of these medications meets coverage criteria before a specialty drug is provided. Review the medical specialty drug list to see which medications require prior authorization.
Novologix is an independent company that provides medical injectable benefit management services on behalf of Healthy Blue. You can reach Novologix at 844-345-2803 from 9 a.m. to 7 p.m. Eastern time, Monday through Friday. You can also complete the Precertification Request for Medical Injectables form and fax it to 866-494-9927.
Synagis is covered for Healthy Blue members under their medical benefit. Please complete the Universal Synagis Prior Authorization Form and fax it to 866-494-9927.
Prior Authorization Forms
- Universal Prior Authorization Request Form: Medications
- Precertification Request for Medical Injectables
- Universal Synagis Prior Authorization Form
Quarterly Pharmacy Formulary Changes
- Quarterly Pharmacy Formulary Changes Effective February 1, 2024
- Quarterly Pharmacy Formulary Changes Effective January 1, 2024
- Quarterly Pharmacy Formulary Changes Effective November 1, 2023
- Quarterly Pharmacy Formulary Changes Effective August 1, 2023
- Quarterly Pharmacy Formulary Changes Effective May 1, 2023
- Quarterly Pharmacy Formulary Changes Effective February 1, 2023 Part II
- Quarterly Pharmacy Formulary Changes Effective February 1, 2023
Related Pharmacy Information
- Drug Medical Policies
- Healthy Blue Formulary Lookup Tool
- Preferred Drug List
- Zero Dollar Copay List
- Over-the-Counter Medication
- Drugs Covered Under Medical Benefit
Drug Medical Policies
Review policies for clinical criteria for all injectable, infused or implanted prescription drugs or therapies which are covered under the medical benefit.
Healthy Blue Formulary
Use the Healthy Blue formulary to see which medications are included.
Preferred Drug List
Healthy Blue has a Preferred Drug List (PDL). Please refer to the 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.
Zero Dollar Copay List
Healthy Blue covers certain drugs that are available at a $0 copay under the pharmacy benefit. Always refer to the latest $0 copay list and refer to the PDL for coverage.
Over-the-Counter Medication
Healthy Blue covers certain over-the-counter (OTC) medications. Be sure to review the latest OTC list and refer to the PDL for coverage.
Drugs Covered Under the Medical Benefit
Prescription drugs are covered in two ways — through the Healthy Blue pharmacy benefit or medical benefit. The method of coverage depends on whether the drug is self-administered or administered by a health care professional in a clinical setting like a doctor’s office.
Drugs that are only administered to members by health care professionals are available under the medical benefit and can be obtained in several ways:
- Buy and bill: Physicians may purchase drugs directly through pharmaceutical wholesalers and distributors and submit a claim to Healthy Blue. To review the list of services and drugs that are billable on the medical benefit for Healthy Blue, please refer to the State Fee Schedule.*
- Delivery: Physicians may request delivery of a member specific specialty medication that will be administered in their office by calling Healthy Blue’s contracted medical specialty pharmacy (MSP), CVS Specialty®.
- Referral: Physicians may refer their members to infusion suites and outpatient hospital services.
Prior authorizations will be handled by NovoLogix, an independent company, on behalf of BlueChoice HealthPlan. To access NovoLogix, sign into My Insurance Manager. Learn more on NovoLogix by exploring the presentation they have for you.
*This link leads to a third-party website. That party is solely responsible for the contents and privacy policy of its site.