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 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
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
- 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.
Preferred Drug List
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.
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.