Pharmacy Information and Tools
We will administer pharmacy benefits for enrolled members. IngenioRX 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
Authorizations online:
To request or check the status of a prior authorization request or decision, please log in to the Availity Portal.
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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
- Prior Authorization Form for Medical Injectables
- Pharmacy Prior Authorization Form
- Behavioral or Psychiatric Conditions Medication Informed Consent
- Hepatitis C Virus Medication Therapy Prior Authorization Form
- Ingrezza or Austedo Statement of Medical Necessity
- Synagis Prior Authorization Request Form