DC pharmacy & prescription drug benefits

Your Wellpoint District of Columbia, Inc. Medicaid plan covers a wide range of prescription drugs. We work with CarelonRx to provide these benefits.

Getting your prescriptions in DC is easy

Your prescription can be sent in electronically by your doctor. Or, you can take your written prescription to a plan pharmacy or ask your doctor to call it in. Be sure to show the pharmacy your Wellpoint DC enrollee ID card.

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

Find a pharmacy

Interested in home delivery?

Get prescriptions delivered straight to your door. Through your secure online account you can also:

Order refills.

Track shipments.

Get notifications.

Have questions about your pharmacy benefits?

Call Pharmacy Enrollee Services at 833-214-3604 (TTY 711), 24 hours a day, seven days a week.

Medications straight to your doorstep

With the ZipDrug pharmacy program, you’ll get customized care at no extra cost. ZipDrug will connect you with a participating local pharmacy. The pharmacy will package your medications by time and day to help you understand what to take and when.

They’ll also schedule hand-delivery at no cost. You may even qualify for one-on-one support from the local pharmacy. They’ll create a personalized care plan to help manage your medications and health conditions.

Here’s how it works:

Call to enroll at 844-947-3784, Monday through Friday, 9:00 a.m. to 5:30 p.m.
Your participating local pharmacy will transfer your prescriptions. They’ll package your medications by time and day and set up refills. That way, all your refills can be received on the same schedule.
Receive your prescriptions by scheduled hand-delivery at no extra cost. When your prescriptions are ready, the pharmacy will call you to schedule delivery for a day and time that’s most convenient.

Discover more about your drug coverage

Wellpoint DC has a list of preferred drugs chosen for quality and effectiveness for enrollees. It’s called a Preferred Drug List (PDL). Since the PDL can change at any time, be sure to check back here for updates.

Many drugs on the PDL don’t need prior authorization (preapproval). However, drugs not mentioned on the list always require prior authorization. This means your doctor must get authorization from us before writing prescriptions for unlisted drugs.

Wellpoint DC Medicaid PDL (English)

Wellpoint DC Medicaid PDL (Spanish)

Wellpoint DC Medicaid PDL (Amharic)

Wellpoint DC Medicaid PDL (Chinese)

Wellpoint DC Medicaid PDL (French)

Wellpoint DC Medicaid PDL (Korean)

Wellpoint DC Medicaid PDL (Vietnamese)

Our formulary is a list of all brand-name and generic drugs available in your plan. Use the formulary to search for drugs by:

Typing the name of the drug in the search box.
Using the A-Z list to search by the first letter of the drug name.
Clicking the therapeutic class of the drug.

If you need a drug that isn’t listed on our formulary, you or your representative can request a formulary exception at submitmyexceptionreq@wellpoint.com.

Search the formulary

Some medicines need prior authorization, or an OK from us, before they can be filled. For those medicines, your doctor must submit a prior authorization request before you can fill your prescription. Your doctor can call CarelonRx at 833-359-1386.

Prior authorizations are necessary for drugs that:

Have the potential for serious side effects.
Should be prescribed only for specific usage.
Have a high misuse or abuse potential.
May cost more than other preferred drugs.

The prior authorization process helps us make sure you’re taking medicines safely and correctly.

You may also need prior authorization when:

Requesting a higher dosage than recommended.
The drug is part of a step-therapy treatment plan.
Requesting a brand-name drug that already has an FDA-approved generic version.

If your doctor recommends a drug that isn’t on our formulary, you may request an exception by emailing us at submitmyexceptionreq@wellpoint.com. Please include a reason why it should be covered.

Understanding your costs

There’s no cost for covered medicines your provider prescribes. Covered drugs include prescription drugs and certain over-the-counter (OTC) medicines.

If you have primary insurance through another carrier and are having trouble getting your copay covered through us, please call CarelonRx at 833-214-3604 (TTY 711). We want to help you, so you don’t have to pay out of pocket when you have both primary insurance and Wellpoint DC.