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Pharmacy and prescription drugs

Doctor speaking with patient image

Your benefits include a wide range of prescription and over-the-counter (OTC) medicines. Healthy Blue works with IngenioRx to provide these benefits.
 

Find a pharmacy    

To find a pharmacy near you, use our pharmacy locator tool. You’ll need to log in to your secure account to use the tool.

Find a pharmacy

Fill a prescription

Bring your member ID card and prescription to a plan pharmacy. Your doctor can also call in the prescription for you. 

It’s good to use the same pharmacy each time you fill a prescription. This way, your pharmacist will know about problems that may happen when you’re taking more than one prescription. If you use another pharmacy, you should tell the pharmacist about all medicines you’re taking.

Your costs

Copays are a set dollar amount you pay for a covered service, like getting a prescription filled.

  • There is a $3.40 copay for members 19 years of age and older for generic or brand-name prescription drugs. Certain over-the-counter medicines are covered with a prescription.    
  • No copays for children under 19 years of age, pregnant women, family planning supplies, members in the hospital for emergency care, members of a home- and community-based waiver, or members getting hospice services.
  • Some medications have no copay when covered under your pharmacy benefit. View the $0 copay drug list:

Make less trips to the pharmacy

Our Medication Synchronization program (Med Sync) makes getting all your medicines easier — at no extra cost to you. Med Sync helps get your refills on the same schedule so you can pick up most of your medicines on the same day each month.

Our Med Sync program can help you:

  • Cut down on trips to the pharmacy
  • Make sure you have your medicines when you need them
  • Work with your pharmacist so you can stick to a medicine routine

Get started with Med Sync today! Talk to your pharmacist about coordinating your 
prescriptions to get started.

Have more questions about Med Sync? Call 1-866-781-5094 (TTY 1-866-773-9634).

Drug coverage information

Your benefits include a wide range of prescription drugs. Healthy Blue also covers many over-the-counter (OTC) medicines with a prescription from your doctor. We have two drug lists that show which drugs are in your plan.

Preferred Drug List (PDL)

The Preferred Drug List (PDL) is the list of drugs that your doctor will use first when prescribing you medicine. These drugs have been chosen for their quality and effectiveness. Your doctor can prescribe most of these medicines to you without getting preapproval, or an “OK,” from us. The PDL is updated frequently.

Searchable formulary

The formulary is a list of all brand-name and generic drugs available in your plan. It lists all the drugs found on the PDL, plus others. All drugs on the formulary are covered, but many require preapproval before the prescription can be filled.

Find your medicine

Do you want to look up your medicine and find out if it is covered in your plan? It’s easy when you use our search tool. This tool will help you learn about any limitations or restrictions for any particular drug.

You can search for your drug by:

  • Typing the name (at least first three letters) of the drug in the search box
  • Using the A-Z list to search by the first letter of your drug
  • Clicking on the therapeutic class of the drug

Search the formulary

Don’t see it listed?
If you don’t see your medicine listed on the PDL, you may ask for an exception at submitmyexceptionreq@amerigroup.com. You’ll be asked to supply a reason why it should be covered, such as an allergic reaction to a drug, etc.

Prior authorizations (preapprovals)

Some medicines need a preapproval, or an “OK,” from Healthy Blue before your provider can prescribe them. The preapproval process helps us make sure that you’re taking medications safely and correctly.

Here are some reasons that preapproval may be needed:

  • There is a generic or pharmacy alternative drug available
  • The drug could be misused or abused
  • There are other drugs that should be tried first
  • The drug has a high side effect potential
  • The drug is being prescribed at a higher dosage than recommended
  • There is additional information needed about your condition so we can match it to the FDA approval of the drug and/or studies of effectiveness

For medicines that need preapproval, your provider will need to call 1-866-902-1689. Healthy Blue will review the request and give a decision within 24 hours. If you need your medicine right away, you may be able to get a 72-hour supply while you wait. 

Need help?

If you misplace your medicine or it is stolen, contact your provider. They will work with the pharmacy and Healthy Blue to review your case and replace your medicines as needed.

If you have any questions about your pharmacy benefit, call Pharmacy Member Services at 1-833-207-3118 (TTY 711) 24 hours a day, seven days a week.

Prescription Drug Reimbursement Forms

If you had to pay for a medicine that is covered under your plan, you may submit a request for reimbursement form.
 

Express Scripts is an independent company that provided pharmacy benefit management services on behalf of BlueChoice HealthPlan prior to October 1, 2019. IngenioRx is an independent company providing pharmacy benefit management services on behalf of BlueChoice HealthPlan.

Get your specialty medications

If you have a complex or chronic health condition that requires special medicine, you can get the medicine you need. We partner with IngenioRx Specialty Pharmacy and other pharmacies to meet all your specialty medication needs.

Learn about specialty pharmacy