Pharmacy and prescription drugs

Have your medicines mailed to you

Did you know you have the option to have maintenance prescription drugs delivered to your home through the mail? You may be able to receive a 90-day supply right to your door. Have a copay? A 90-day supply through home-delivery costs the same as a 30-day supply from a retail pharmacy.

Why sign up for mail-order prescriptions?

• Safety: You don’t have to leave home — your prescriptions are sent right to you.
• Convenience: Easily order refills by phone or online — and with 90-day supplies, you refill less often.
• Savings: If you have a copay, you only pay the 30-day amount for your 90-day supply.

Use this form to set up home delivery for your prescription.

• Home Delivery Form - English
• Home Delivery Form - Spanish

Find out if your prescription is covered

Preferred Drug List (PDL)

Empire has a list of preferred drugs chosen for their quality and effectiveness. It’s called a Preferred Drug List (PDL).

Many of the drugs listed on the PDL do not need preapproval. Drugs not listed on the PDL always require preapproval. This means your doctor must get approval from us before they can write a prescription for the drug. Go to the preapprovals section below for more information.

The PDL can change at any time. Please check back for updates.

Searchable formulary

The formulary is a list of all brand-name and generic drugs available in your plan. It lists both drugs found on the PDL and others not listed on the PDL. Use our searchable 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.

Essential Plan members

Medicaid members

CHPlus members

HARP members

Don’t see it listed?

If you need to take a drug not listed in the formulary, you may request an exception at submitmyexceptionreq@empireblue.com. You’ll be asked to supply a reason why it should be covered, such as an allergic reaction to a drug.

Managing your prescription

Prescription Drug Reimbursement Form

• CarelonRx Reimbursement Form – English
• CarelonRx Reimbursement Form – Spanish

Preapprovals

Some medicines need a preapproval, or an OK, from us before your doctor can prescribe them. Drugs that require preapproval will be listed with PA next to the drug name. For those medicines, your doctor must get preapproval before you can fill your prescription. Your doctor can get this by calling our Pharmacy department.

Drugs that require preapproval include those that:

• Have high side-effect potential
• Should be prescribed only for specific usage
• Have 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.

Other times you may need preapproval are:

• When requesting a higher dosage than recommended
• When requesting a brand-name drug that already has an FDA-approved generic version
• When the drug is part of a step therapy treatment plan. Step therapy means trying less expensive options before "stepping up" to drugs that cost more.