Pharmacy

Use the Healthy Blue Comprehensive Drug Lookup Tool to see which medications are included.

Healthy Blue has a Healthy Blue Comprehensive Drug List. Please refer to the Comprehensive Drug List when prescribing for our members. This guide does not contain a complete list of drugs; rather, it lists the comprehensive drugs within the most commonly prescribed therapeutic categories.

SCDHHS implemented a sPDL for all participating Manage Care Organizations (MCOs). Review additional resources available to you. 

Healthy Blue covers certain over-the-counter (OTC) medications. Be sure to review the latest OTC list.

Prescription drugs are covered in two ways — through the Healthy Blue pharmacy benefit or medical benefit. The method of coverage depends on whether the drug is self-administered or administered by a health care professional in a clinical setting like a doctor’s office.

Drugs that are only administered to members by health care professionals are available under the medical benefit and can be obtained in several ways:

• Buy and bill: Physicians may purchase drugs directly through pharmaceutical wholesalers and distributors and submit a claim to Healthy Blue. To review the list of services and drugs that are billable on the medical benefit for Healthy Blue, please refer to the State Fee Schedule.*
• Delivery: Physicians may request delivery of a member specific specialty medication that will be administered in their office by calling Healthy Blue’s contracted medical specialty pharmacy (MSP), CVS Specialty^®.
• Referral: Physicians may refer their members to infusion suites and outpatient hospital services.

Prior authorizations will be handled by NovoLogix, an independent company, on behalf of BlueChoice HealthPlan. To access NovoLogix, sign into My Insurance Manager.  Learn more on NovoLogix by exploring the presentation they have for you.

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