Pharmacy Benefits

Healthy Blue works with CarelonRx to provide a wide range of prescription and over-the-counter (OTC) medicines. 

Find A Pharmacy

Use our pharmacy locator tool to find a pharmacy in the Healthy Blue network. You will have to log in to access this tool. 

Fill A Prescription

Filling a prescription is easy:

  • Bring your member ID card and prescription to a in-network pharmacy. 

  • Your doctor can also call in the prescription for you. 

  • Use the same pharmacy each time to avoid any issues when you take more than one medicine. 

  • If you use more than one pharmacy, tell the pharmacist about the medicines you’re taking. 

     

Med Sync

Make getting your medications easier at no cost with our Medication Synchronization program (Med Sync). This program helps you get your refills on a schedule, allowing you to pick up most of your medicine on the same day each month. 

The Med Sync program can help: 

  • You make fewer trips to the pharmacy. 

  • Make sure you always have your medicine refilled on time. 

  • You stick to a medicine routine. 

Get started with Med Sync by calling Pharmacy Member Services at 866-781-5094 (TTY: 866-773-9634).

 

Get Your Medicine Mailed to You

We want to make sure you can access your prescription as easily as possible. Log in to your My Health Toolkit® account to start managing your prescriptions and get them mailed right to your house. 

Comprehensive Drug List

The Comprehensive Drug List is the list of drugs that your doctor will use first when giving you medicine. These drugs have been chosen based on their quality. Most of these medicines can be prescribed without getting an “OK” from us.

Searchable Comprehensive Drug List

Find a list of all the medicines that are covered in your plan. You can search by: 

  • Name
  • Filtering the list A to Z
  • Clicking on the class of drugs. 

Don't See Your Medicine?

If your medicine is not listed on our Comprehensive Drug List, you can ask for an exception. You can submit your exception at submitmyexceptionreq@carelon.com. A reason why your medicine should be covered will need to be submitted with the request.

Prior Authorization

There are medicines that have to have prior approval from us for your doctor to prescribe them. This process helps us make sure you are taking medications safely and correctly. 

 

You will need prior authorization for medications if: 

  • There is an alternative drug available. 

  • Abuse of the drug is possible. 

  • There is an alternative treatment. 

  • The drug has potential for high side effects. 

  • The prescription is higher than the recommended dosage. 

  • We need more information about your condition. 

Your provider can call 844-410-6890 for Healthy Blue to review the request. The decision will be made within 24 hours. If you can’t wait on the decision, you may be able to get a 72-hour supply while you wait. 

Need Help?

Contact your provider if: 

  • You misplaced your medicine. 

  • Your medicine was stolen. 

     

Call Pharmacy Member Services at 866-781-5094 (TTY: 866-773-9634) if you have questions about your pharmacy benefits. You can call the pharmacy member services 24 hours a day, 7 days a week. 

Prescription Drug Reimbursement Forms

You can submit a request for reimbursement if you ever have to pay for a medicine that is covered under your plan. 

 

CarelonRx Reimbursement Form — English

CarelonRx Reimbursement Form — Spanish

Specialty Medications

You can get special medications if you have a complex or chronic health condition that requires it. 

 

SCDHHS Preferred Drug List

The SCDHHS Preferred Drug List is the list of drugs the state wants your doctor to use. These drugs are also included in the Comprehensive Drug List. 

CarelonRx is an independent company that provides pharmacy benefit management services on behalf of BlueChoice HealthPlan.