Pharmacy information

Resources for providers including preferred drug lists (PDLs), prior authorization information and other related resources.

Pharmacy benefits manager

Wellpoint administers pharmacy benefits for enrolled members. Most medications are covered without prior authorization, but a few require you to contact our pharmacy department for prior approval.

CarelonRx

Wellpoint pharmacy contact information

Pharmacy help desk

Call: 888-483-0801

Fax: 800-531-7787

Prior authorization for physician-administered drugs

Call: 877-375-6158

Fax: 844-487-9290

Pharmacy services and requirements

National Drugs Codes (NDCs)

Providers must include national drug codes (NDCs), unit of measurement and quantity of drug on all Wellpoint claims, including physician-administered drugs. This applies to drugs dispensed in both professional and institutional outpatient settings.

West Virginia’s Bureau for Medical Services (BMS) requires that Wellpoint report NDC information every month. BMS submits this data to pharmaceutical manufacturers to obtain rebates under the Medicaid Drug Rebate Program. Following these instructions is important for West Virginia to receive timely Medicaid Drug Rebates from drug manufacturers.

Preferred drug list (PDL) inquiries

The PDL is part of the pharmacy service provided by BMS and is located on the Preferred Drug List page of the BMS website.

West Virginia Preferred Drug List (PDL)

West Virginia Bureau for Medical Services (BMS)

Physician-administered drug requirements

Wellpoint will deny professional and outpatient institutional claims containing physician-administered drugs if any of the following elements are missing or invalid:

NDC*
Unit of measurement
Quantity of drug

*The NDC is an 11-digit code on the package or container from which medication is administered.

Outpatient infusion pharmaceuticals

Billing requirements for outpatient infusion pharmaceuticals apply to drugs such as chemotherapy, hydration and antibiotics used during each outpatient infusion therapy visit. An important exception is for blood and blood products, which are billed under the Other Services category. Specific codes and service dates are required; guidance for relevant billing and HCPCS codes can be found in the provider manual.

Additional pharmacy resources

For prior authorization requirements specific to pharmaceuticals including specialty medications, please visit the prior authorization requirements page.