Pharmacy and prescription drug benefits
Your benefits include a wide range of prescription and over-the-counter (OTC) drugs. We work with CarelonRx to provide these benefits.
Costs
Your cost, or copay, for non-preferred brand drugs is $3. There’s a $1 copay for generic drugs, preferred brand drugs, and HIV/AIDS drugs. Members under age 21, those who are pregnant, members in long-term care, and American Indians do not have a copay.
How to get your prescriptions
Getting your prescription filled is easy. Simply take your written prescription to a plan pharmacy or ask your doctor to call it in. Be sure to show the pharmacy your Wellpoint member ID card.
Have your medicines mailed to you
Log in to your account and request your prescriptions be filled through home delivery services. With your secure online account, you can:
- Order refills
- Track your shipments
- Get notifications
Medications straight to your doorstep
With the Community Pharmacy Total Care program, you’ll get customized care at no extra cost. Community Pharmacy Total Care 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 no cost hand-delivery. 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 a.m. to 5:30 p.m. Eastern time.
- Your prescriptions will be transferred by your participating local pharmacy. They’ll package your medications by time and day and set up refills so they’re 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.
Drug coverage information
Prescription drug list (PDL)
Wellpoint has a list of preferred drugs chosen for their quality and effectiveness. It’s called a Preferred Drug List (PDL). Many of the drugs listed on the PDL do not need preapproval. Drugs not listed on the PDL always require preapproval. This means your doctor must get approval from us before he or she can write a prescription for the drug. Go to the preapprovals section, below, for more information.
The PDL can change at any time. Please check back for updates.
You can also get OTC medicines with a prescription from your doctor.
Find your medicine
The formulary is a list of all brand-name and generic drugs available in your plan. It lists the drugs found on the PDL and other drugs not found on the PDL. You can use the searchable 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 someone you choose to act for you can request a formulary exception. Just email submitmyexceptionreq@Wellpoint.com.
Pharmacy forms
If you had to pay for a medicine that is covered under your plan, you may submit a request for reimbursement form.
The PDL can change at any time. Please check back for updates.
Preapprovals
Some medicines need a preapproval, or an OK from us, before your doctor can prescribe them. Drugs that require preapproval will be listed with PA next to the drug name. For those medicines, your doctor must submit a preapproval request before you can fill your prescription. Your doctor can call Provider Services at 800-454-3730 or fax the form to 844-487-9292.
Drugs that require preapproval include those that:
- Can have high side effect potential
- Should be prescribed only for specific usage
- Have a high misuse or abuse potential
- May cost more than other preferred drugs
The preapproval process helps us make sure you’re taking medicines safely and correctly.
Other times you may need preapproval are:
- When requesting a higher dosage than recommended
- When the drug is part of a step therapy treatment plan
- When 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. You’ll be asked to give a reason why it should be covered.
Member resources
Your member handbook is your go-to-guide for health services. Read it to find out about:
- How to use your benefits
- How to choose a primary care provider
- How to get help if your doctor’s office is closed
- How to reach Wellpoint Member Services if you have questions
- Your rights and responsibilities as a Wellpoint member
Need a handbook mailed to you?
Let a Member Services representative know via Live Chat.
