Pharmacy information
Wellpoint District of Columbia, Inc. works with CarelonRx to administer pharmacy benefits for enrollees.
Medicaid
Please refer to the Preferred Drug List (PDL) when prescribing for our enrollees. 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.
Medicaid formulary
The Wellpoint District of Columbia, Inc. drug formulary contains a comprehensive list of drugs in commonly prescribed therapeutic categories, including preferred and non-preferred drugs, and drugs requiring prior authorization.
Wellpoint District of Columbia, Inc. Formulary
Tools and medical coverage resources
Find Care tool
Need to get a prescription filled or find an in-network provider? Use our Find Care tool.
Find a Pharmacy
Need to get a prescription filled or find an in-network provider? Find a plan pharmacy nearby.
Pharmacy prior authorizations
Pharmacy prior authorization phone:
Available 8:00 am – 6:00 pm
Pharmacy prior authorization electronic:
ePrescribe (ePA) through CoverMyMeds
Pharmacy outpatient drugs:
Fax the Pharmacy Prior Authorization Form to
844-487-9292
Medical injectable drugs:
Fax the Medical Injectable Prior Authorization Form to
844-487-9294
Mail order pharmacy
Wellpoint District of Columbia, Inc. offers mail-order pharmacy services for certain drugs through CarelonRx’s home delivery pharmacy. Obtain mail-order pharmacy services:
By phone
By fax
800-378-0323
Specialty pharmacy
Wellpoint District of Columbia, Inc. offers specialty pharmacy services for certain drugs through our preferred specialty vendor, CarelonRx Specialty Pharmacy. Obtain specialty pharmacy services:
By phone
By fax
833-263-2871
Related information
Medicaid formulary, drug criteria and limitations
Prior authorization lookup tool
Pharmacy Prior Authorization Form
Medical Injectable Prior Authorization Form
Medication code requirements for drugs billed under the medical benefit
Analgesic Opioid Prior Authorization Form
Analgesic Opioid Quantity Limits
Analgesic Opioid Clinical Criteria
Pharmacy Medical Step Therapy Requirements
Hot Tips
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 enrollees, contact Provider Services, and we’ll prepare a Pharmacy Hot Tip for you!
Hot Tip: Atypical Antipsychotics
Interested in becoming a provider in the Wellpoint District of Columbia network?
We look forward to working with you to provide quality service for our enrollees.