Pharmacy information

Empire BlueCross BlueShield HealthPlus (Empire) will administer pharmacy benefits for enrolled members. IngenioRX* is the pharmacy benefits manager.

Medicaid preferred drug list (formulary)

Please refer to the Preferred Drug List (formulary) from Empire 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: Medicaid

Searchable formulary: Essential Plan

Searchable formulary: Child Health Plus (CHPlus)

Searchable formulary: Health and Recovery Plan (HARP)

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 Empire. 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

Fax:

1-844-493-9206

Prior Authorization forms for pharmacy services can be found on the Forms page.

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