North Carolina Alliance for Healthy Communities

Prescription Drug Coverage: Non Medicare / Commercial Plans

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Prescription Drug Coverage & Medication Management

(Highlights drug coverage by plan, prior approval guidelines, critical forms and other helpful information for healthcare providers and consumers)

Plan Name (alphabetical order)	Company Name	Formulary List Site / pdf	Prior Authorization Criteria	Prior Authorization Form Site / Specialty Medication Forms	Specific Forms by Drug	Mail Order/Specialty Pharmacy	Other Helpful Links	Workers Compensation
Aetna	Aetna	Online Searchable Formulary	Prior Authorization Criteria	Prior Authorization Forms	Yes	Mail Order Pharmacy	N/A	Main Website Pharmacy Program
BCBS of NC	BCBS of NC	Online Searchable Formulary	Prior Authorization Criteria	Prior Authorization Forms	Yes	Mail Order Pharmacy	N/A	Statement on Workers Compensation Coverage
Caremark	Caremark	Online Searchable Formulary	Prior Authorization Criteria	Prior Authorization Forms	N/A	Health Management Program through Accordant	N/A	N/A
Cigna	Cigna	Online Searchable Formulary	Prior Authorization Criteria	Prior Authorization Forms	No	Specialty Medication Form Speciality Pharmacy	Other Medical, Dental, and Pharmacy Forms	Pharmacy Benefit (Scriptnet) Participating Pharmacy Finder
Coventry Wellpath	Coventry Wellpath	Online Searchable Formulary	Prior Authorization Criteria	Prior Authorization Forms	No	Mail order Exclusion List Mail order Form	N/A	General Website
Express Scripts	Express Scripts	Online Searchable Formulary (must register with website to access)	Prior Authorization Criteria	Prior Authorization Forms	N/A	N/A	N/A	Workers Compensation
Federal Blue Cross Blue Shield	BCBS	Online Searchable Formulary for Basic and Standard Plans	Prior Authorization Criteria	Prior Authorization Forms	Yes	Mail Order Pharmacy Mail Order Form	Other Pharmacy Forms Including Overseas, Mail order, and Retail Reimbursement Forms	N/A
First Carolina Care	First Carolina Care	Printable Formulary Online Search	Prior Authorization Criteria	Prior Authorization Forms	Yes	Mail Order	N/A	Workers Compensation Claim Form
Medco	Medco	Online Searchable Formulary	Prior Authorization Criteria	Prior Authorization Forms	No	Mail Order Accredo Specialty Pharmacy	N/A	N/A
NC Health Choice for Children	NC Health Choice for Children	Printable Formulary	Prior Authorization Criteria	Prior Authorization Forms	No	Mail Order Pharmacy	Other Medical and Pharmacy Forms	N/A
North Carolina Medicaid	North Carolina Medicaid	Printable Formulary	Prior Authorization Criteria	Prior Authorization Forms	Yes	N/A	N/A	N/A
North Carolina State Health Plan	North Carolina State Health Plan	Printable Formulary	Prior Authorization Criteria	Prior Authorization Forms	Yes	Mail Order Specialty Pharmacy	Other Medical and Pharmacy Forms	General Website
TriCare	TricCare	Online Searchable Formulary	Prior Authorization Criteria	Prior Authorization Forms	No	Mail Order Pharmacy	N/A	Workers Compensation General Website Participating Pharmacy Finder
United Healthcare	United Healthcare	Printable Formulary	N/A	N/A	No	Specialty Medication Enrollment Forms	Personalized Medication Website	Online Claims Submission
Veterans Administration	Veterans Administration	Online Searchable Formulary	N/A	Prior Authorization Form	N/A	N/A	Personalized Health Website	N/A