Wellpoint has a list of preferred drugs chosen for quality and effectiveness for New Jersey members. 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 preapproval. Drugs not mentioned on the list, though, always require preapproval. This means your doctor must get approval from us before writing prescriptions for unlisted drugs.
Some medicines need preapproval, or an OK from us, before they can be filled. 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 833-731-2143 or fax the request to 844-487-9292.
Preapprovals 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 preapproval process helps us make sure you’re taking medicines safely and correctly.
You may also need preapproval 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 the list, you may request an exception by emailing us at submitmyexceptionreq@Wellpoint.com. Please include a reason why it should be covered.
Wellpoint will pay up to $15 every quarter for certain over-the-counter (OTC) products like Tylenol, Band-Aids, and other wellness items. All you need is your member ID card and a prescription from your doctor that can be used at any participating pharmacy. Please call Member Services at 833-731-2147 (TTY 711) for more information.
Copays are a set dollar amount you pay for covered services, like doctor visits or prescriptions. Your copay for prescription drugs depends on what plan you’re in. Members under age 21, those who are pregnant, and members in long-term care don’t have copays.
NJ FamilyCare A, B and ABP
If you are a NJ FamilyCare member in Plan A, B, or ABP, you don’t have a copay for prescriptions.
NJ FamilyCare C and D If you are a NJ FamilyCare member in Plan C or Plan D, you pay $5 for brand-name drugs and $1 for generic drugs.