Pharmacy information and tools
Healthy Blue will administer pharmacy benefits for enrolled members through CarelonRx, Inc. CarelonRx, Inc. is an independent company providing pharmacy benefit management services on behalf of BlueChoice HealthPlan.
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.
Though most medications on the PDL are covered without prior authorization, a few agents will require you to contact our Pharmacy department for authorization.
The Online searchable formulary is a list of all brand-name and generic drugs available in the plan. It lists all the drugs found on the PDL, plus others.
- Quarterly Pharmacy Formulary Changes effective 5/1/2023
- Quarterly Pharmacy Formulary Changes effective 2/1/2023 Part II
- Quarterly Pharmacy Formulary Changes effective 2/1/2023
- Quarterly Pharmacy Formulary Change Effective November 1, 2022
- Quarterly Pharmacy Formulary Change Effective August 1, 2022
- Quarterly pharmacy formulary change notice effective May 1, 2022
- Quarterly pharmacy formulary change notice effective February 1, 2022
- Quarterly pharmacy formulary change notice effective November 1, 2021
- Ivermectin formulary change notice effective October 24, 2021
- Growth hormone formulary change notice effective September 20, 2021
Electronic prior authorizations
Electronic prior authorization requests can be submitted through CoverMyMeds®. CoverMyMeds is an independent company providing medication prior authorization services on behalf of BlueChoice HealthPlan.
CoverMyMeds streamlines the medication prior authorization process, electronically connecting providers, pharmacists and plan/PBMs to improve time to therapy and decrease prescription abandonment with electronic prior authorization.
Using CoverMyMeds for prior authorization (PA) requests
Prescribers can view real-time status of any medication PA request submitted via ePA, phone, or fax by logging into the CoverMyMeds website and entering the member’s information. Prescribers also have the option to contact CoverMyMeds directly by calling 866-452-5017 for questions, information, or website concerns, or via live chat on the CoverMyMeds website.
Prior authorizations by phone
You can reach our Pharmacy department 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 Saturday.
Prior authorizations by fax
You can also fax your request to our Pharmacy department at the following:
- Retail Prior Authorization — 844-512-9005
- Medical Injectables — 844-512-7027
Specialty medications are high-cost injectable drugs that generally require close supervision and monitoring of the patient’s drug therapy. These drugs often require special handling such as temperature-controlled packaging and overnight delivery and are often unavailable at retail pharmacy stores. Office-based injectables are typically covered under the medical benefit while self injectable medications are typically covered under the pharmacy benefit. Medications designated as specialty medications are found on the Preferred Drug List and noted as SP (Specialty Pharmacy).
Healthy Blue uses a separate specialty pharmacy network for dispensing of specialty medications that are covered under the pharmacy benefit. Our participating specialty pharmacies provide special care when a specialty drug is dispensed. In addition, these pharmacies assist members who have complex medical conditions to stay compliant with their specialty drug regimens.
Benefits of using a specialty pharmacy
Members receive individualized care from health care professionals who are trained in specialty medications and in the member’s condition. This includes patient care representatives, nurses and pharmacists.
Shipping, including special handling of refrigerated medications, is done at no cost.
Members receive refill reminders to assist them in keeping on schedule with taking medications.
Pharmacy Hot Tips are brief messages to help answer questions and/or concerns you may have around a variety of pharmacy topics. Topics include 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!
- Rx Hot Tip Acne
- Rx Hot Tip ADHD
- Rx Hot Tip Allergies
- Rx Hot Tip Asthma
- Rx Hot Tip Atypical Antipsychotics
- Rx Hot Tip Chronic Pain
- Rx Hot Tip Diabetes
- Rx Hot Tip Diabetic Meter and Test Strips
- Rx Hot Tip Medication Assisted Treatment (MAT) of Opioid Use Disorder
- Rx Hot Tip Over-the-Counter (OTC) Preferred Products
- Rx Hot Tip Proton Pump Inhibitors
- Rx Hot Tip Topical Corticosteroid
- Rx Hot Tip ADHD; Rx Hot Tip Asthma
- 90 Day Supply Drug List
- IngenioRx Home Delivery Provider Notification
- Facts About Generic Drugs
- Preferred Drug List (PDL) Introduction
- Common Over-the-Counter (OTC) Medications
- Formulary Search Guide
- Zero Dollar Copay List
Guide to Drug Coverage Under Medical Benefit
Provider Tools & Resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview