New Jersey Providers

Pharmacy information


Wellpoint will administer pharmacy benefits for enrolled members. CarelonRx* is the pharmacy benefits manager.

Medicaid

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.

Though most medications on the PDL are covered without prior authorization, a few agents will require you to contact our Pharmacy Department for authorization.

Contact our Pharmacy Department


Pharmacy Department:

1-833-731-2149
Available 8:00 a.m. to 8:00 p.m. EST Monday through Friday;
10:00 a.m. to 2:00 p.m. EST on Saturday.

Prior authorizations by fax:


Retail prior authorization:

1-844-509-9863

Medical injectables:

1-844-509-9865

Medicare

Please refer to the formulary when prescribing for Medicare members. Though most medications on the formulary are covered without prior authorization, a few agents will require you to obtain an authorization.

For Medicare Part B, contact:


Provider Services

1-866-805-4589 (Select option 5)
8:00 a.m. – 8:00 p.m. local time; Monday to Friday

For Medicare Part D, contact:


CarelonRx Provider Services

1-833-293-0659

Medicare Part D Rx coverage determinations and appeals

Providers can send a request for a prescription coverage determination for a Medicare plan via electronic prior authorization (ePA) rather than fax or phone by submitting the request from CoverMyMeds or SureScripts.

CoverMyMeds

Hot Tips:

Pharmacy Hot Tips are brief messages that provide information on 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 your Provider Relations representative, and we will prepare a pharmacy Hot Tip for you!

Related information

Provider tools & resources

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We look forward to working with you to provide quality services to our members.