Pharmacy Information and Tools

We will administer pharmacy benefits for enrolled members. CarelonRx is the pharmacy benefits manager.

Medicaid

Please refer to the  Preferred Drug List (PDL) when prescribing for our members. This guide does not contain a complete list of drugs; rather, it lists the preferred drugs within the most commonly prescribed therapeutic categories.

Though most medications on the  PDL are covered without prior authorization, a few agents will require you to contact our Pharmacy Department for authorization.

Please refer to the Pharmacy tab listed under Resources for more information regarding upcoming PDL changes.

Drug Lookup Tool

To use the drug lookup tool, select here > Tools > Drug Lookup

Searchable Formulary Tool (Pharmacy Benefit)

Searchable Formulary

Over-The-Counter (OTC) Drug List

OTC Drug List

Electronic prior authorizations (ePA)

Electronic prior authorization requests can be submitted through CoverMyMeds, an independent company providing medication prior authorization services on behalf of Summit Community Care.

CoverMyMeds streamlines the medication prior authorization process, electronically connecting providers, pharmacists, and plan/Pharmacy Benefit Managers (PBMs) to improve time to therapy and decrease prescription abandonment with electronic prior authorization.

Using CoverMyMeds for prior authorization (PA) requests

Prescribers can view real-time status of any medication PA request submitted via ePA, phone, or fax by logging into the CoveryMyMeds website and entering the member’s information. Prescribers also have the option to contact CoverMyMeds directly by calling 866-452-5017 for questions, information, or website concerns, or via live chat on the CoverMyMeds website.

Authorizations online:

To request or check the status of a prior authorization request or decision, please log in to the Availity Portal.

Need help with Availity?   Learn more.

Authorizations by phone:

Call — 1-844-462-0022
Hours — 8 a.m.-8 p.m. (Eastern time) Monday-Friday
              10 a.m.-2 p.m. (Eastern time) Saturday

Authorizations by fax:

Retail Prior Authorization — 1-844-429-7761
Medical Injectables — 1-844-429-7762

For a complete list of Pharmacy Prior Authorizations Forms, click here > Pharmacy.

Hot Tips

Pharmacy Hot Tips are brief messages to help answer questions and/or concerns you may have around a variety of pharmacy topics. Topics include preferred formulary products used to treat common diseases and conditions.

If you would like additional pharmacy information to assist our members, contact your Provider Relations representative, and we will prepare a pharmacy Hot Tip for you!