Pharmacy information and tools
Wellpoint works with CarelonRx to administer pharmacy benefits for enrolled members.
Please refer to the Preferred Drug List (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.
Most medications on the PDL are covered without prior authorization, but there may be some that require you to contact our Pharmacy department for authorization.
Pharmacy prior authorizations
Call the Wellpoint Pharmacy department at 1-833-707-0868 Monday to Friday from 8 a.m. to 8 p.m. Eastern time, or 10 a.m. to 2 p.m. on Saturday.
Fax your request to our Pharmacy department.
Pharmacy outpatient drugs: Fax the Pharmacy Prior Authorization Form to 1-844-490-4871.
Medical injectable drugs: Fax the Medical Injectable Prior Authorization Form to 1-844-490-4873.
Mail order pharmacy
Wellpoint offers mail-order pharmacy services for certain drugs through CarelonRx’s home delivery pharmacy. To obtain mail-order pharmacy services:
Call our mail-order provider number at 1-833-203-1742.
Fax your mail-order request to 1-800-378-0323.
Medicaid formulary, drug criteria and limitations
Prior authorization lookup tool
- State Hepatitis C Clinical Criteria
- State Hepatitis C Sample Treatment Plan
- Hepatitis C Therapy Prior Authorization Form
- State Hepatitis C Retreatement Form
- Synagis Enrollment Form
- Pharmacy Corner
- Pharmacy Presentation
- State Opioid Prescribing Guidance and Policy (Resource)
- State Opioid Prescribing Policy
- Analgesic Opioid Quantity Limits
- Analgesic Opioid Clinical Criteria
Pharmacy Hot Tips are brief messages to help to provide 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 Provider Services, and we’ll prepare a Pharmacy Hot Tip for you!
Provider tools and resources
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