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)

Health and Recovery Plan (HARP) PDL

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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