Pharmacy

My Insurance Manager

File claims, get prior authorizations, check eligibility and benefits and more.

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Prior Authorizations:

CarelonRx

CarelonRx Inc. is an independent company providing pharmacy benefit management services on behalf of Healthy Blue.

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 fax your request to the following numbers:

NovoLogix will manage prior authorizations for medical injectables and specialty medication drugs.

CoverMyMeds®

CoverMyMeds is an independent company providing medication prior authorization services on behalf of Healthy Blue.

Prescribers can view real-time status of any medication prior authorization (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 Authorization Forms:

Note: For Synagis authorizations, please contact Utilization Management at 866-757-8286.
 

Grievances and Appeals:

If for any reason you want a decision reconsidered or to file a complaint, please complete the form and send using one of the following:

Mail to Address:  
        CarelonRx Grievances and Appeals
        P.O. Box 775370
        St. Louis, MO 63177

Fax: 844-430-6802
Email: RxGrievanceandAppeals@carelon.com 
 

Specialty Medications 

Specialty medications often are 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.

Quarterly Pharmacy Formulary Changes

Related Pharmacy Information

Review policies for clinical criteria.

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.