Pharmacy information and tools

Highmark Blue Cross Blue Shield (Highmark BCBS) will administer pharmacy benefits for enrolled members. CarelonRx, Inc. is the pharmacy benefits manager for Child Health Plus and Essential Plan members, and all members needing Medicaid and Health and Recovery Plan (HARP) can add benefits on a fee-for-service basis.

CarelonRx, Inc. is an independent company providing pharmacy benefit management services on behalf of the health plan.

Medicaid and HARP members

Pharmacy benefits and prior authorization requests for Medicaid and HARP members should be submitted to NYRx.

Preferred Drug List (formulary)

Please refer to the Preferred Drug List (PDL) formulary 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. We also cover some commonly prescribed over-the-counter (OTC) medications. Medications not listed in the formularies are considered to be non-formulary and are subject to prior authorization.

Electronic prior authorizations (ePA)

Electronic prior authorizations requests can be submitted through CoverMyMeds, an independent company providing medication prior authorization services on behalf of Highmark BCBS.

CoverMyMeds streamlines the medication prior authorization process, electronically connecting providers, pharmacists, and plan/PBMs to improve time to therapy and decrease prescription abandonment with electronic prior authorization.

Using CoverMyMeds for prior authorization (PA) requests

Prescribers can view real-time status of any medication 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 by phone:

You can reach our Pharmacy department at 866-231-0847 between 8 a.m. and 7 p.m. Eastern time Monday through Friday and 10 a.m. to 2 p.m. Eastern time on Saturday.