Pharmacy information and tools

Highmark Blue Cross Blue Shield will administer pharmacy benefits for enrolled members. CarelonRx* is the pharmacy benefits manager.

* CarelonRx, Inc. is an independent company providing pharmacy benefit management services and some utilization review services on behalf of Highmark Blue Cross Blue Shield.

Child Health Plus (CHPlus) Preferred Drug List (formulary)

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. We also cover some commonly prescribed over-the-counter (OTC) medications. Please refer to our OTC List when prescribing these medications for our members.

Electronic prior authorizations (ePA)

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

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 authorizations by phone:

You can reach our Pharmacy department at 1-866-231-0847 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.

Phone:

1-866-231-0847

Prior authorizations by fax:

You can also fax your request to our Pharmacy department:

Retail prior authorization:

1-844-490-4877

Medical Injectables:

1-844-493-9206

Documents

Related information

NYS DOH Single Statewide Medication Assisted Treatment (MAT) Formulary

Guide to Drug Coverage Under Medical Benefit

Precertification forms

Precertification Lookup

Hot Tips:

Pharmacy Hot Tips are brief messages to help answer questions and/or concerns you may have around a variety of pharmacy topics. Topics include preferred formulary products used to treat common diseases and conditions such as asthma and diabetes.