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Medicaid Providers

Pharmacy information and tools

Blue Cross and Blue Shield of North Carolina arranged for IngenioRx to be the Pharmacy Benefits Manager (PBM) for Healthy Blue members.

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

Please note that some medications on the PDL may require a prior authorization. 

Electronic prior authorizations (ePA)

Electronic prior authorization requests can be submitted through CoverMyMeds, an independent company providing medication prior authorization services on behalf of Blue Cross and Blue Shield of North Carolina for Healthy Blue members.

CoverMyMeds streamlines the medication prior authorization process, electronically connecting providers, pharmacists, and plan/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 CoverMyMeds 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.

Prior authorizations by phone:

You can reach Provider Services at 844-594-5072.

Prior authorizations by fax:

You can also fax your request to our Pharmacy Department.

Prior authorization forms

Prior Authorization from Availity:

You can also request a pharmacy prior authorization by logging into the Availity Portal:

  1. Log into Availity.com.
  2. From the Availity home page, select Patient Registration from the top navigation.
  3. Select Authorizations.
  4. Select General Pharmacy

Formulary Searchable Tool (Pharmacy Benefit)

 

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 such as asthma and diabetes.
 
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!
 

Related information

 

Provider tools & resources

Interested in becoming a provider in the Healthy Blue network?

We look forward to working with you to provide quality services to our members.