Prior Authorizations:
To search for authorization by code, use the Medical Specialty Drug List Lookup Tool.
CarelonRx
CarelonRx Inc. is an independent company providing pharmacy benefit management services on behalf of Healthy Blue.
View the Healthy Blue Comprehensive Drug List lookup 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.
CVS/Novologix
CVS/Novologix is an independent company that provides medical injectable benefit management services on behalf of Healthy Blue. You can reach CVS/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.
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.
Synagis is covered for Healthy Blue members under their medical benefits. 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
Comprehensive Drug List Changes
- Comprehensive Drug List Change Notice Effective November 1, 2024
- Comprehensive Drug List Change Notice Effective October 1, 2024
- Comprehensive Drug List Change Notice Effective September 1, 2024
- Comprehensive Drug List Change Notice Effective July 1, 2024
- 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
Medical Specialty Drug List Lookup Tool
Please verify benefit coverage prior to rendering services.
Please note:
- Enter one HCPCS code at a time into the search.
- This tool is for medical specialty drugs only.
- This tool does not reflect benefits coverage. Refer to your provider manual for coverage/limitations.
- These codes are valid as of 8/1/2024.