Pharmacy information
Anthem Blue Cross and Blue Shield (Anthem) will administer pharmacy benefits for Child Health Plus (CHPlus) or Essential Plan enrolled members. CarelonRx Inc.* is the pharmacy benefits manager.
Preferred Drug List (formulary)
Please refer to the Preferred Drug List (formulary) 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. Medications not listed in the formulary are considered to be non-formulary and are subject to prior authorization.
Searchable formulary: Essential Plan
Prior authorization requests
Some drugs, drug combinations and drug doses require prior authorization (PA). To submit electronic prior authorization (ePA) requests online, use Availity *.
Prior authorization phone and fax numbers
While online submissions helps streamline the PA process, you may also initiate a new PA request by calling or faxing a completed Pharmacy Prior Authorization form to Anthem. Please note, the following contact numbers for prior authorization requests and PA form information below.
Prior authorization phone
Hours: Monday to Friday 8:00 a.m. to 7:00 p.m.; Saturday 10:00 a.m. to 2:00 p.m.
Phone:
1-800-450-8753
Prior authorization for retail pharmacy
Fax:
1-844-490-4877
Prior authorization for medical injectables (including Medicaid members)
Fax:
1-844-493-9206
Prior authorization for oncology medical injectables, such as medical benefit requests (Essential Plan members only)
Fax:
1-855-201-8530
Prior Authorization forms for pharmacy services can be found on the Forms page.
Related resources
Prior authorization lookup tool
- Common OTC Medications List
- Rx hot tip acne
- Rx hot tip ADHD
- Rx hot tip allergies
- Rx hot tip asthma
- Rx hot tip asthma (pediatric)
- Rx hot tip atypical antipsychotic
- Rx hot tip chronic pain
- Rx hot tip diabetes
- Rx hot tip medication assisted treatment (MAT) of opioid use disorder
- Rx hot tip proton pump inhibitors
- Rx hot tip topical corticosteroid
- Rx hot tip diabetic supplies
*CarelonRx is an independent company providing pharmacy support services on behalf of Anthem Blue Cross and Blue Shield.
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Reimbursement Policies
- Provider Manuals, Policies & Guidelines
- Referrals
- Provider Training Academy
- Forms
- Pharmacy Information
- Provider News & Announcements