Medicaid Pharmacy Benefits in New Jersey

Getting your prescriptions in NJ is easy

Simply take your written prescription to a plan pharmacy or ask your doctor to call it in. Remember to show the pharmacy your Wellpoint member ID card.

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.

Prescription drug member forms

Prescription Drug Home Delivery Form (English)

Prescription Drug Home Delivery Form (Spanish)

Have questions about your pharmacy benefits? Call Pharmacy Member Services, 24 hours a day, seven days a week at 833-207-3115 (TTY 711).

Medications straight to your doorstep

With the Community Pharmacy Total Care pharmacy program, you’ll get customized care at no 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 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 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 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.

Preferred Drug List (English)

Preferred Drug List (Spanish)

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 833-731-2149 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 our formulary, you or your care provider 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.

Over-the-counter medicines at no or low cost to you

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.
Selecting the therapeutic class of the drug.

Search the formulary

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.

Understanding your costs

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.