Pharmacy information and tools
As of October 1, 2025, prescription pharmacy benefits are managed by CarelonRx, Inc.
Medicaid
Please refer to the Louisiana Medicaid Single PDL (Fee For Service and Managed Care Organizations) when prescribing for these members. This guide does not contain a complete list of drugs; rather, it lists the preferred drugs within the most-commonly-prescribed therapeutic categories, including prior authorization criteria, quantity limits, and covered diabetic supplies. The list displays both preferred and non-preferred covered drugs.
Though most medications on the PDL are covered without prior authorization, a few agents will require you to contact our Pharmacy department for authorization.
Prior authorizations by phone
For medical injectables, you can reach CarelonRx at 844-521-6942 between 7 a.m. and 7 p.m. CT, Monday through Friday, and 9 a.m. to 1 p.m. CT on Saturday. Calls received after hours are handled by CarelonRx’s Second Level staff, a 24-hour service.
Pharmacy department:
844-521-6942
Medical injectables:
844-521-6942
Prior authorizations by fax
You can also fax your prior authorization request to CarelonRx.
Retail prior authorization:
855-592-0978
Medical injectables:
844-487-9291
Healthy Blue Dual Advantage
Please refer to the
formulary
when prescribing for Medicare members. Though most medications on the formulary are covered without prior authorization, a few agents will require you to obtain an authorization. For Medicare Part B, contact the Provider Services department at 844-521-6942 between 7 a.m. and 7 p.m. Central time, Monday through Friday, and 9 a.m. to 1 p.m. Central time on Saturday.
Medicare Part D
For Medicare Part D, contact CarelonRx Provider Services.
CarelonRx Provider Services:
833-293-0659
Medicare Part D Rx coverage determinations and appeals
Providers can send a request for a prescription coverage determination for a Medicare plan via electronic prior authorization (ePA) rather than fax or phone by submitting the request from the ePA website:
Healthy Blue Dual Special Needs Plan (D-SNP)
The Healthy Blue Dual Special Needs Plan (D-SNP) offers a variety of benefits designed to help keep your patients healthy while protecting them from unexpected costs.
Healthy Blue Medicaid formulary
The medications included in the Healthy Blue formulary are reviewed and approved by the Louisiana Department of Health , which includes practitioners and pharmacists.
Medications not listed in the formulary are considered to be non-formulary and are subject to prior authorization.
Some medications listed may have additional requirements or limitations of coverage. These requirements and limits may include prior authorization, quantity limits, age limits, or step therapy.
Use the PDL/NPDL to search for name-brand and generic drugs that are on your formulary:
Related information
Resources
*CarelonRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Healthy Blue.
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Provider Manuals and Guides
- Referrals
- Forms
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)