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Pharmacy & prescription drugs

We offer a wide range of prescription and over-the-counter (OTC) drugs, home delivery and more. We work with CarelonRx to provide these benefits.

To find a pharmacy near you, use our pharmacy locator tool.

Find a pharmacy

Your costs

Copays are a set dollar amount you pay for a covered service, like getting a prescription filled.

Medicaid members

Your copay for prescriptions is $3 for non-preferred brand-name drugs, $1 for preferred brand-name drugs, and $1 for generic drugs. Members under age 21 and pregnant women do not have copays.

Starting April 1, 2020, your maximum pharmacy co-payment (co-pay) will be $50 per quarter year (3 months). The co-pay maximum re-sets each quarter, no matter what amount you paid last quarter.

The quarters are:

  • First quarter: January 1 – March 31
  • Second quarter: April 1 – June 30
  • Third quarter: July 1 – September 30
  • Fourth quarter: October 1 – December 31

If you are unable to pay the requested co-pay, you should tell the provider. The provider cannot refuse to give you services or goods because you are unable to pay the co-pay. Unpaid co-pays are a debt you owe the provider.

To learn more about co-pays, please call Member Services at 1-866-231-0847 (TTY 711).

CHPlus members

There are no copays for covered drugs.

Preferred Drug List

Highmark BCBSWNY has a preferred drug list (PDL), also called a formulary. It includes all medicines covered by Medicaid and Child Health Plus (CHPlus). Your doctor doesn’t have to get preapproval to prescribe medicines on this list. If your doctor wants to prescribe a drug that isn’t on this list, he or she will need to get preapproval from us before you can fill your prescription.

When there is a generic drug available, it will be covered. Generic drugs are equal to brand-name drugs and approved by the Food and Drug Administration. Requests for brand-name drugs when generics are available will need preapproval. You can email us to ask for an exception.

Medicaid members

CHPlus members

If you have any questions about your pharmacy benefit, call Pharmacy Member Services at 1-833-232-1713 (TTY 711) 24 hours a day, seven days a week.

Searchable Formulary

Search for brand-name and generic drugs that are on your medication list.

You can search for your drug by:

  • Typing the name (at least first three letters) of the drug in the search box.
  • Using the A-Z list to search by the first letter of your drug. OR
  • Clicking on therapeutic class of the drug.

Other helpful resources

Medicaid members

Medicaid Searchable Formulary

CHPlus members

CHPlus Searchable Formulary

Common Over-the-Counter (OTC) medicines

Simply take your written prescription to a plan pharmacy or ask your doctor to call it in. Be sure to show the pharmacy your member ID card.

It’s good to use the same pharmacy each time you fill a prescription. This way, your pharmacist will know about problems that may happen when you’re taking more than one prescription. If you use another pharmacy, you should tell the pharmacist about any medicines you’re taking.

Our new Medication Synchronization program (Med Sync) makes getting all your medicines easier – at no extra cost to you. Med Sync helps align your refill schedules so you can pick up most of your medicines on just one day each month.

Our Med Sync program can help you:

  • Cut down on trips to the pharmacy.
  • Make sure you have your medicines when you need them.
  • Work with your pharmacist so you can stick to a medicine routine.

Get started with Med Sync today!

Talk to your pharmacist about coordinating your prescriptions to get started. Have more questions about Med Sync? Call 1-833-232-1713 (TTY 711).

Have your medicines mailed to you

We make getting your prescriptions filled as convenient as possible. You can log in to your account and have prescriptions filled through home delivery services. With your secure online account, you can:
  • Order refills
  • Track your shipments
  • Get notifications
Log in to your account

Pharmacy Forms

Prescription Drug Reimbursement Form
Prescription Drug Home Delivery Form

Get your specialty medications

If you have a specialty condition, you’re covered. We partner with IngenioRx Specialty Pharmacy to meet all your specialty medication needs.

Learn more about specialty pharmacy

How can I find out what pharmacies are in the Highmark BCBSWNY plan?

You can look in your new member enrollment package for a list of pharmacies in our plan. Or you can search our list of plan drugstores online. You can also call Pharmacy Member Services at 1-833-232-1713 (TTY 711) 24 hours a day, seven days a week or ask your local pharmacy for help.

Are over-the-counter (OTC) products covered, and do I need a prescription?

We cover many OTC products, including pain relievers, antacids, contraceptives and some vitamins. All OTC products require a written prescription from your doctor and can be filled at any drugstore in our plan.

How does my doctor request preapproval?

Your doctor can call our Pharmacy department at 1-866-231-0847 (TTY 711).

What if a copay is required and I’m unable to pay it?

If you don’t have the required copay, your pharmacy (drugstore) should still provide the medicine. You will have to pay the copay at a later time.

How do I get medicine if I’m traveling?

We have pharmacies in our plan in all 50 states. If you need a refill while on vacation, ask your doctor for a new prescription to take with you. You can also ask your doctor to fax it to the closest drugstore in our plan where you’ll be visiting.

What happens if my medicines are lost or stolen?

If your medicines are lost or stolen, you should contact your doctor. Ask your doctor to authorize the pharmacy to refill your prescription early. The pharmacy may have to contact us for preapproval. Replacement of lost or stolen medicines will be reviewed on a case-by-case basis.

What if I paid out of pocket for a medicine and want to be reimbursed?

If you had to pay for a medicine, you may submit a request for reimbursement. You’ll need to mail a completed reimbursement request form along with any receipts to:

Commercial/Medicaid Claims Department
P.O. Box 52065
Phoenix, AZ 85072-2065

Will I be able to receive my enteral nutrition, diapers and medical supplies through a pharmacy?

Enteral nutrition, diapers and durable medical equipment (DME) can be obtained through your (DME) benefit. You can get some medical supplies from your local pharmacy, like bandages, insulin syringes and glucose test strips.

Enroll in Highmark BCBSWNY