WA pharmacy and prescription drug benefits

Get prescriptions delivered straight to your door. Through your secure online account you can also:

• Order refills
• Track shipments
• Get notifications

Log in to your Wellpoint account 

Do you have medicines you take regularly to treat a chronic condition? If so, you can fill up to a 90-day supply at retail pharmacies. You can refill your prescription every:

• 72 days for a 90-day supply.
• 24 days for a 30-day supply.

If you’re going on vacation, you can get up to a 90-day supply for each of your prescriptions. Ask your pharmacy to call us and request a vacation supply of your medication. Or you can call CarelonRx Member Services at 833-207-3121 (TTY 711).

If your prescription is lost, stolen, or destroyed, you can ask for an early refill once every six months. Your refill will include up to a 90-day supply if you fill your prescription at a pharmacy or use mail order. To request an early refill, call CarelonRx Member Services at 833-207-3121 (TTY 711).

During emergencies, you can ask your pharmacy for a seven-day emergency supply of your medicines. An emergency might be when:

• There's a natural disaster.
• You’re transitioning from incarceration.
• Your pharmacist believes you have an urgent health need.

If you need more than a seven-day emergency supply, your pharmacist can call the Pharmacy Help Desk anytime at 833-253-4453.

The Apple Health Preferred Drug List (PDL) is a list of brand name and generic drugs available on your plan. These drugs are chosen for their quality and effectiveness. Your doctor will use this PDL first when prescribing your medicines.

Go to the Apple Health Preferred Drug List 

We also cover medicines and supplies that are not included in the Apple Health Preferred Drug List (PDL). You can use our Wellpoint PDL to find things like diabetic supplies, spacers, and vaccines. We chose these items for their quality and effectiveness.

Our formulary is a list of all brand-name and generic drugs available in your plan. Use the formulary to search for drugs by:

• Typing the name of the drug in the search box
• Using the A-Z list to search by the first letter of the drug name
• Clicking the therapeutic class of the drug
   

Search the formulary 

If you need a drug that isn’t listed on our formulary, you or your representative can request a formulary exception at submitmyexceptionreq@wellpoint.com.

Some medicines need preapproval or an okay from us before they can be filled. For those medicines, your doctor must submit a preapproval request before you can fill your prescription. Your doctor can call CarelonRx Member Services at 833-207-3121 (TTY 711).

Preapprovals are necessary for drugs that:

• Have the potential for serious side effects.
• Should be prescribed only for specific usage.
• Have a high misuse or abuse potential.
• May cost more than other preferred drugs.

The preapproval process helps us make sure you’re taking medicines safely and correctly.

You may also need preapproval when:

• Requesting a higher dosage than recommended.
• The drug is part of a step-therapy treatment plan.
• Requesting a brand-name drug that already has an FDA-approved generic version.

If your doctor recommends a drug that isn’t on our formulary, you may request an exception by emailing us at submitmyexceptionreq@wellpoint.com. Please include a reason why it should be covered.

We partner with CarelonRx Specialty Pharmacy to meet all your specialty medication needs.

Learn more about specialty pharmacy 

There’s no cost for covered medicines your provider prescribes.

If you have primary insurance through another carrier and are having trouble getting your copay covered through us, please call CarelonRx Member Services at 833-207-3121 (TTY 711). We want to help you, so you don’t have to pay out of pocket when you have both primary insurance and Wellpoint.

Did you accidentally pay for a medicine that is covered under your plan? Submit a request for reimbursement:

CarelonRx Reimbursement Form (English)
 

CarelonRx Reimbursement Form (Spanish)

For members ages 19 and older, we cover all vaccines recommended by the Centers for Disease Control and Prevention (CDC). You may be able to get these vaccines at your pharmacy. Ask your pharmacist about vaccines you may need.

Vaccines for members ages 18 and younger are covered through the Vaccines for Children Program. Ask your doctor about vaccines your child may need.

Wellpoint covers all forms of family planning with a prescription from your doctor. At no cost, you can get birth control pills, rings, patches, and shots; condoms; and intrauterine devices (IUDs) and birth control implants. You can also get emergency contraception if you need it. Learn more about family planning covered by Wellpoint.

Some products may require a prescription from your doctor. Over the Counter (OTC) birth control, such as condoms and most emergency contraceptives (e.g., morning after pill), can be obtained when billed by a pharmacy without a prescription or a visit to your doctor. For a list of covered OTC birth control products, see the Apple Health covered OTC contraceptive list.

The Health Care Authority (HCA), Apple Health, and Wellpoint are committed to safe pain management. In 2019, the HCA created a policy for opioid use that limits the quantity of pain medications members can fill. Patients undergoing active cancer treatment or who are in hospice, palliative care, or end-of-life care are exempt from this policy. Read more about the Health Care Authority’s opioid policy.

Wellpoint covers naloxone (Narcan) to treat opioid overdose without a prescription. For more information, ask your pharmacist or call CarelonRx at 833-207-3121 (TTY 711).

We cover all medicines to treat substance use disorder. Talk to your provider about substance use disorder treatment.