You pay nothing for these drugs and supplies covered under your Original Medicare medical benefit. 2023 All Rights Reserved. Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Some medicines need a preapproval or an OK from the Anthem HealthKeepers Plus plan before your provider can prescribe them. If you dont have Adobe Acrobat Reader, you can download a free copy by clicking HERE. Drugs for cosmetic purposes or hair growth. Simply take your written prescription to a plan pharmacy or ask your doctor to call it in. Medicare evaluates plans based on a 5-Star rating system. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689(TTY: 711 ). The drug has a high side effect potential. MedicareRx (PDP) plans. or union group and separately issued by one of the following plans: Anthem Blue If you need more medicine than the standard 34-day supply to treat a condition, you can ask us for prior authorization. This list is for members who have the Medicare Supplement Senior SmartChoice plan. Visit theAppeals & Grievancessection for more information. are Independent Licensees of the Blue Cross and Blue Shield Association, If you need your medicine right away, you may be able to get a 72-hour supply while you wait. You can log in to your account and manage your prescriptions filled through home-delivery pharmacy. 'https:' : 'http:') + Massachusetts, Rhode Island, and Vermont. Your Medicare Part D prescription benefit is a 5-tier structure. A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. are currently taking the brand name drug. Customer Support To help ensure a smooth member transition and minimize costs, providers should review these changes and consider prescribing a drug on formulary or on a lower tier, if appropriate. . Please see PDPFinder.com or MAFinder.com for current plans. Local, state, and federal government websites often end in .gov. You should always verify cost and coverage information with your Medicare plan provider. The benefit information provided is a brief summary, not a complete description of benefits. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), Contact Anthem Blue Cross and Blue Shield. If you dont see your medicine listed on the drug lists, you may ask for an exception at submitmyexceptionreq@anthem.com or by calling Pharmacy Member Services at 833-207-3120.Youll be asked to supply a reason why it should be covered, such as an allergic reaction to a drug, etc. Check with your employer or contact the Pharmacy Member Services number on your ID card if you need assistance. 2023 Medicare HMO Blue Formulary. Blue MedicareRx Value Plus (PDP) and Blue MedicareRx Premier (PDP) are two Generic drugs have the same active ingredient formula as a brand name drug. or add a special coverage requirement. Electronic prescribing, or e-Prescribing, lets the doctor who prescribes your medicines send your information right to a retail or mail-order drugstore in your plan. This list only applies if you have a specialty pharmacy network included in your benefit. Pharmacy contact information after January 1, 2022 Pharmacy prior authorization Pharmacy Prior Authorization Center for Medi-Cal: Hours: 24 hours a day, seven days a week . or union group and separately issued by one of the following plans: Anthem Blue are Independent Licensees of the Blue Cross and Blue Shield Association, Additionally, Anthem offers a statewide Health Maintenance Organization Plan Option for eligible members and pre-65 Retirees, as well as Medicare Advantage Premium and Standard Plan Options to Medicare-eligible members. Y0014_22146 Certain drugs on Blue MedicareRx formularies have special coverage requirements to ensure theyre used in a safe way and to help Blue MedicareRx covers most Part D vaccines at no cost to you (and for our Value Plus plan, even if you haven't paid your deductible). Small Group 2023 Select Drug List (Searchable) | (PDF) Small Group 2022 Select Drug List (Searchable) | (PDF) Espaol. : , . A doctor can also call in the prescription for you. Important Message About What You Pay for Insulin - You won't pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it's on even if you haven't paid your deductible, if applicable. Anthem Blue Cross is the trade name of Blue Cross of California. These requirements include: If you believe your use of a drug meets all special requirements, or that you should be exempt from a requirement, You must continue to pay your Medicare Part B premium. The joint enterprise is a Medicare-approved Part D Sponsor. Through Anthem, SHBPoffers eligible members, including pre-65 Retirees a choice of three Health Reimbursement Arrangement (HRA) Plan Options: Gold HRA, Silver HRA and Bronze HRA. UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs. Drugs that would be covered under Medicare Part A or Part B. Your benefits include a wide range of prescriptions and over-the-counter (OTC) medicines. Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Enrollment in Blue MedicareRx (PDP) depends on contract renewal. Getting your prescriptions filled is easy. By law, certain types of drugs or categories of drugs are not covered under Medicare Part D. The formulary was last updated on 03/01/2023 andmay change during the year. You can compare Anthem Medicare Advantage plans available where you live to find a plan that covers the prescription drugs you need. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia con el idioma. Tier assignments vary by plan. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. In Connecticut: Anthem Health Plans, Inc. For all medically billed drug (Jcode) PA requests, please continue to send those directly to Anthem for review. Limitations, copayments, and restrictions may apply. If you don't see your medicine listed on the drug lists, you may ask for an exception at submitmyexceptionreq@anthem.com or by calling Pharmacy Member Services at 833-207-3120. These kinds of medicines arent paid for by your plan: Click here to see the list of medications available for 90-day supply. Use of the Anthem websites constitutes your agreement with our Terms of Use. Prior authorization phone and fax numbers All prior authorizations will be managed by MedImpact. We rely on objective evaluations from independent physicians. View can also view our Rx Maintenance 90 pharmacies, where you can obtain up to a 90-day supply of your medicine, by going to the Rx Networks page. FormularyID, (Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2022 ). The drug is prescribed at a higher dosage than recommended. Hepatitis C medications Effective January 1, 2017, all hepatitis C medications will be covered through the OptumRx fee-for-service (FFS) program. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins. We may not tell you in advance before we make that change-even if you You may also submit your request online through Cover My Meds, Surescripts, or CenterX ePA portals. This is known as prior authorization. There is no pharmacy copay for Cardinal Care and FAMIS members.. To get Nevada Medicaid benefits through Anthem, you must have limited income and live in one of our service areas. If a change affects a drug you take, we will notify you at least 60 days in advance, Coverage is available to residents of the service area or members of an employer gcse.type = 'text/javascript'; See how we help keep your out-of-pocket costs low for the medications you and your family need. pharmacies in our network, over 22,000 3. Get the mobile app Visit the Blue Shield of Vermont. BAA !KOHWIINDZIN DOO&G&: Din4 kehj7 y1n7[tigo saad bee y1ti 47 t11j77ke bee n7k1adoowo[go 47 n1ahooti. If you use another pharmacy, you should tell the pharmacist about all medicines you are taking. Visit thePrior Authorization and Step Therapysection for more information. Note: Not all prescriptions are available at mail order. o You can search for generic drugs at anthem.com. PlanID Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. If a sudden removal occurs, we will notify our affected members as soon as possible. Generally, a drug on a lower tier will cost less than a drug on a higher tier. 2021 copyright of Anthem Insurance Companies, Inc. As a leader in managed healthcare services for the public sector, Anthem Blue Cross and Blue Shield Medicaid helps low-income families, children and pregnant women get the healthcare they need. Your benefits include a wide range of prescription drugs. Type at least three letters and well start finding suggestions for you. It lists all the drugs found on the PDL, plus others. Off-label drug use, which means using a drug for treatments not specifically mentioned on the drugs label. When you fill your prescription D77 bee an7tah7g7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689(TTY: 711). Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. var cx = 'partner-pub-9185979746634162:fhatcw-ivsf'; How you know. Anthem MediBlue Rx Plus (PDP) (S5596-057-0) Benefit Details. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag1-800-472-2689(TTY: 711 ). Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Out of the 63,000+ To conduct a search, enter the Medication Name or select a Therapeutic Category or TherapeuticClass. All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members. Please refer to the Provider Manual for more details on medical coverage: We look forward to working with you to provide quality services to our members. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Reminder: Use Diagnosis Codes On All Pharmacy PA Requests. Your doctor can prescribe most of these medicines to you without getting preapproval or an OK from us. var s = document.getElementsByTagName('script')[0]; Medicare MSA Plans do not cover prescription drugs. New! Well make sure you can get the quantity of medicines you need. Your doctor can get the process started by calling the Pharmacy Member Services number on We partner with CarelonRx Specialty Pharmacy and AcariaHealth to meet all your specialty medication needs. '//cse.google.com/cse.js?cx=' + cx; Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. For specific information, check your Member Handbook or call the number on your ID card. If a medication does not appear on this formulary, a prescription drug prior authorization form will need to be completed by the prescriber and submitted to Anthem Blue Cross (Anthem) before the prescription may be filled. One of these lists may apply to you if your plan includes the PreventiveRx benefit (members can receive certain preventive drugs at low or no cost). Please call 844-336-2676 or fax all retail pharmacy PA requests to 858-357-2612 beginning July 1, 2021. 500 MG VIAL [Zithromax], Everyone in your household can use the same card, including your pets. MA-Compare: Review Changes in each 2021 Medicare Advantage Plan for 2022, Find a 2022 Medicare Part D Plan (PDP-Finder: Rx Only), Find a 2022 Medicare Advantage Plan (Health and Health w/Rx Plans), Q1Rx 2022 Medicare Part D or Medicare Advantage Plan Finder by Drug, Guided Help Finding a 2022 Medicare Prescription Drug Plan, Search for 2022 Medicare Plans by Plan ID, Search for 2022 Medicare Plans by Formulary ID, 2022 Medicare Prescription Drug Plan (PDP) Benefit Details, 2022 Medicare Advantage Plan Benefit Details, Pre-2020 Medicare.gov Plan Finder Tutorial, Example: AARP MedicareRx Preferred (PDP) Formulary in Florida, Learn more about savings on Pet Medications, ABACAVIR-LAMIVUDINE 600-300 MG TABLET [Epzicom], ABIRATERONE ACETATE 250 MG TABLET [ZYTIGA], Acamprosate Calcium DR 333 MG tablets [Campral], ACETAMINOPHEN-COD #3 TABLET [Tylenol with Codeine No.3], ACETAZOLAMIDE ER 500 MG CAPSULE ER [Diamox Sequels], ACETYLCYSTEINE 20% VIAL [Mucosil Acetylcysteine], ADEFOVIR DIPIVOXIL 10 MG TABLET [Hepsera], ADVAIR HFA 230; 21ug/1; ug/1 120 AEROSOL, METERED in 1 INHALER, ADVAIR HFA INHALER 115;21MCG;MCG 120 ACTN INHL, ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL, ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA], ALBUTEROL SUL 0.63 MG/3 ML SOLUTION VIAL-NEB [Accuneb], ALBUTEROL SUL 1.25 MG/3 ML SOLUTION VIAL-NEB, ALBUTEROL SUL 2.5 MG/3 ML SOLUTION VIAL-NEB, ALCLOMETASONE DIPR 0.05% OINTMENT [Aclovate], ALENDRONATE SOD 70 MG/75 ML SOLUTION [Fosamax], ALENDRONATE SODIUM 10 MG TABLET [Fosamax], ALENDRONATE SODIUM 35 MG TABLET [Fosamax], ALENDRONATE SODIUM 70 MG TABLET [Fosamax], AMILORIDE HCL-HCTZ 5-50 MG TABLET [Moduretic], Amino acids 4.25% in dextrose 10% Injectable Solution [Clinimix 4.25/10], Amino acids 4.25% in dextrose 5% Injectable Solution [Clinimix 4.25/5], AMLODIPINE BESYLATE 10 MG TABLET [Norvasc], AMLODIPINE BESYLATE 2.5 MG TABLET [Norvasc], AMLODIPINE BESYLATE 5 MG TABLET [Norvasc], AMLODIPINE-BENAZEPRIL 10-20 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 10-40 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 2.5-10 CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 5-10 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 5-20 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 5-40 MG CAPSULE [Lotrel], AMLODIPINE-OLMESARTAN 10-20 MG TABLET [AZOR], AMLODIPINE-OLMESARTAN 10-40 MG TABLET [AZOR], AMLODIPINE-OLMESARTAN 5-20 MG TABLET [AZOR], AMLODIPINE-OLMESARTAN 5-40 MG TABLET [AZOR], AMLODIPINE-VALSARTAN 10-160 MG TABLET [Exforge], AMLODIPINE-VALSARTAN 10-320 MG TABLET [Exforge], AMLODIPINE-VALSARTAN 5-160 MG TABLET [Exforge], AMLODIPINE-VALSARTAN 5-320 MG TABLET [Exforge], AMMONIUM LACTATE 12% CREAM (g) [Lac-Hydrin], AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE [Augmentin], AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET [Augmentin], AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE [Augmentin], AMOX-CLAV 400-57 MG/5 ML ORAL SUSPENSION [Augmentin], AMOX-CLAV ER 1,000-62.5 MG TABLET [Augmentin], AMOXICILLIN 200 MG/5 ML ORAL SUSPENSION [Amoxil], AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION [Trimox], AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [Amoxil], Ampicillin 1000 MG / Sulbactam 500 MG Injection, Ampicillin 125mg/1 10 VIAL, GLASS in 1 PACKAGE / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS, Anagrelide Hydrochloride 0.5mg/1 100 CAPSULE BOTTLE, APOMORPHINE 30 MG/3 ML CARTRIDGE [Apokyn], Apraclonidine 5 MG/ML Ophthalmic Solution, ARIPIPRAZOLE ODT 10 MG TABLET RAPDIS [Abilify Discmelt], ARIPIPRAZOLE ODT 15 MG TABLET RAPDIS [Abilify Discmelt], ASENAPINE 10 MG SUBLIGUAL TABLET [Saphris], ASENAPINE 2.5 MG TABLET SUBLIGUAL [Saphris], ASENAPINE 5 MG SUBLIGUAL TABLET [Saphris], ASPIRIN-DIPYRIDAM ER 25-200 MG CPMP 12HR [Aggrenox], ATAZANAVIR SULFATE 150 MG CAPSULE [Reyataz], ATAZANAVIR SULFATE 200 MG CAPSULE [Reyataz], ATAZANAVIR SULFATE 300 MG CAPSULE [Reyataz], ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT), ATOMOXETINE HCL 10 MG CAPSULE [Strattera], ATOMOXETINE HCL 100 MG CAPSULE [Strattera], ATOMOXETINE HCL 18 MG CAPSULE [Strattera], ATOMOXETINE HCL 25 MG CAPSULE [Strattera], ATOMOXETINE HCL 40 MG CAPSULE [Strattera], ATOMOXETINE HCL 60 MG CAPSULE [Strattera], ATOMOXETINE HCL 80 MG CAPSULE [Strattera], ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [Mepron], Atovaquone-Proguanil 250; 100mg/1; mg/1 [Malarone], AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION [Zithromax], AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [Zithromax], AZITHROMYCIN 250 MG TABLET [Zithromax Z-Pak], AZITHROMYCIN 500 MG TABLET [Zithromax Tri-Pak], AZITHROMYCIN 600 MG TABLET [Zithromax Z-Pak], AZITHROMYCIN I.V. Massachusetts, Blue Cross & Blue Shield of Rhode Island, and Blue Cross and For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. Effective with dates of service on and after October 1, 2020, and in accordance with the IngenioRx Pharmacy and Therapeutics (P&T) process, Anthem Blue Cross (Anthem) will update its drug lists that support commercial health plans. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen1-800-472-2689(TTY: 711 ). during the calendar year will owe a portion of the account deposit back to the plan. This group meets regularly to review new and existing drugs, and to choose the top medications for our Drug List/Formulary. OTC drugs aren't shown on the list. Find an Anthem Medicare Advantage plan that offers prescription drug coverage. Prescription vitamins and minerals (except for prenatal vitamins and fluoride preparations). However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. All pharmacy services billed as a pharmacy claim (and their electronic equivalents), including outpatient drugs (prescription and over the counter), physician- administered drugs (PADs), medical supplies, and enteral nutritional products are in scope for pharmacy under Medi-Cal. the plan cover a drug that is not included in the formulary. We offer an outcomes-based formulary. If you are a member with Anthems pharmacy coverage, click on the link below to log in and automatically connect to the drug list that applies to your pharmacy benefits. Please call 844-336-2676 or fax all retail pharmacy PA requests to 858-357-2612 beginning July 1, 2021. and SM Service Marks are the property of their respective owners. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service Drugs on the formulary are organized by tiers. Blue Shield of Vermont. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont March 2023 Anthem Provider News - Indiana, February 2023 Anthem Provider News - Indiana, New ID cards for Anthem Blue Cross and Blue Shield members - Indiana, Telephonic-only care allowance extended through April 11, 2023 - Indiana, January 2023 Anthem Provider News - Indiana, September 2022 Anthem Provider News - Indiana. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. Drugs requiring the assistance of a medical professional (office-based injectables) are not covered under the pharmacy benefit. To ensure a smooth member transition and minimize costs, providers should review these changes and consider prescribing a drug on formulary or on a lower tier, if appropriate. You may ask us to cover a Medicare Part D medication not listed on our formulary by requesting a formulary exception to waive coverage restrictions or limits on your medication. Anthem is a registered trademark. How to use the Anthem Blue Cross Cal MediConnect Formulary. SM, TM Registered and Service Marks and Trademarks are property of their respective owners. In Indiana: Anthem Insurance Companies, Inc. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Learn more about Blue Ticket to Health Get your flu shot Flu shots, pneumonia shots, FluMist TM and antiviral medications are approved benefits under most health plans. Use the Drug Pricing Tool to price the medications you are currently taking and see which Blue MedicareRx plan is best for you. All drugs on these lists are approved by the Food and Drug Administration (FDA). Attention Prescribing Providers with members who are enrolled in an Anthem California plan: The Prescription Drug Prior Authorization Or Step Therapy Exception Request Form must be used for all members enrolled in a California plan, regardless of residence. Anthem is a registered trademark of Anthem Insurance Companies, Inc. The benefit information provided is a brief summary, not a complete description of benefits. This is a list of drugs we will cover in 2023, including preferred and non-preferred drugs. Hours: Monday to Friday from 8 a.m. to 7 p.m. Eastern time. For Medi-Cal: Call Customer Service at 800-977-2273. Drugs on the formulary are organized by tiers. Please note, this update does not apply to the Select Drug List and does not affect Medicaid and Medicare plans. Contact the Medicare plan for more information. })(); This is archive material for research purposes. Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele 1-800-472-2689 TTY: 711 ). View a summary of changes here . 2023 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN This formulary was updated on 08/30/2022. lower tier might work for you. Anthem Blue Cross and Blue Shield Medicaid (Anthem) will administer pharmacy benefits for enrolled members. The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), whichunderwrites or administersthe PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare Health Services Insurance Corporation (Compcare) underwritesor administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. All other drugs are limited to a 34-day supply. Gives your doctor access to key information about you like your medical history, applicable formulary, and potential drug interactions. For more information contact the plan. Anthem Blue Cross and Blue Shield Medicaid is the trade name of Anthem Kentucky Managed Care Plan, Inc., independent licensee of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use. The joint enterprise is a Medicare-approved Part D Sponsor. You won't pay more than $35 for a one-month supply of each insulin product covered by Blue MedicareRx, no matter what cost-sharing tier it's on (and for our Value Plus plan, even if you haven't paid your deductible). View the upcoming formulary changes for * IngenioRx, Inc. is an independent company providing pharmacy benefit management services and some utilization review services on behalf of Anthem Blue Cross and Blue Shield. See individual insulin cost-sharing below. We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. Anthem Blue Cross is the trade name of Blue Cross of California and Anthem Blue Cross Partnership Plan is the trade name of Blue Cross of California Partnership Plan, Inc. If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. This process is called preapproval or prior authorization. Featured In: Medallion Medicaid/FAMIS: 1-800-901-0020 Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) 2019 List of Covered Drugs (Formulary), Medi-Cal Managed Care and Major Risk Medical Insurance Program Provider Manual, Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Provider Manual, MMP: Medical Injectables Prior Authorization Form, Drug List Addition/Clinical Criteria Change Request Form. Medically necessary office-based injectables are covered under the major medical benefit. Generally, Medicaid members are in the following categories: Under age 21 A pregnant woman A family with children Childless adult aged 19-64 who meets federal income requirements See if you're eligible. Massachusetts, Rhode Island, and Vermont. The PDL is updated frequently. That means we use a balanced approach to drug list/formulary management, based on a combination of research, clinical guidelines and member experience. Independent licensees of the Blue Cross Association. Cross and Blue Shield of Connecticut, Blue Cross Blue Shield of Select your search style and criteria below or use this example to get started The Pharmacy and Therapeutics (P&T) Committee picks drugs considered to be the top choices based on their safety, effectiveness and value for our Drug List/Formulary. you and/or your doctor must request a coverage determination before the plan will cover your drug. If you have the Essential formulary/drug list, this PreventiveRx drug list may apply to you: If you have the National formulary/drug list, one of these PreventiveRx drug lists may apply to you: If you have the National Direct formulary/drug list, one of these PreventiveRx drug lists may apply to you: Anthem has aligned the National and Preferred Drug Lists. ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstutzung zur Verfugung. This tool will help you learn about any limitations or restrictions for any rug. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. The formulary, also known as a drug list, for each Blue MedicareRx plan includes most eligible generic and brand-name drugs. 2022 Formulary for Open Enrollment This is a list of drugs we will cover in 2023, including preferred and non-preferred drugs. You can also learn more about some of our online tools, like pricing a drug, by clicking on the link to the video. Drugs not approved by the U.S. Food and Drug Administration (FDA). For medicines that need preapproval, your doctor will need to call 844-336-2676 Monday through Friday from 8 a.m.-7 p.m. MedImpact will review the request and give a decision within 24 hours. It features low $1 copays for tier 1 prescription drugs. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. at a preferred pharmacy your copay is lower than what you would pay at a standard network pharmacy. ZIP & Plan An Anthem Medicare Advantage Plan that covers prescription drugs will include a formulary, which is a list of drugs that are covered by the plan. Individual 2022 Select Drug List (Searchable) | This version of the Select Drug List applies to Small Group plans if your coverage is through a Small Group employer on, and in some cases, off the exchange. Featured In: September 2020 Anthem Blue . If you're not sure whether these lists apply to your plan, check with your employer or call the Pharmacy Member Services number printed on your ID card. 2021 Blue Cross and Blue Shield of Massachusetts, Inc., or Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. April 1 through September 30, 8:00 a.m. to 8:00 p.m. (change state) In Kentucky: Anthem Health Plans of Kentucky, Inc. In certain situations, you can. Since 2014, Anthem Blue Cross and Blue Shield of Georgia (Anthem)has provided medical claims administration and medical management services for the State Health Benefit Plan (SHBP). Blue MedicareRx (PDP) is accepted coast-to-coast at national pharmacy chains and grocery retailers, plus thousands of community-based independent pharmacies. ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont drug on our Drug List, but immediately move it to a different cost-sharing (Updated 02/01/2023) This ensures that our members use these drugs in a safe way. The PDL includes all medications covered by Medicaid, including some over-the-counter drugs. Its easy when you use our search tool. The Blue Cross and Blue Shield of Illinois (BCBSIL) Prescription Drug List (also known as a Formulary) is designed to serve as a reference guide to pharmaceutical products. Be sure to show the pharmacy your Anthem member ID card. This plan is closed to new membership. , 1-800-472-2689(: 711 ). ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid. The P&T Committee is an independent group that includes practicing doctors, pharmacists and other health care professionals responsible for the research and decisions surrounding our Drug List/Formulary. Make sure you can search for generic drugs at anthem.com OTC ) medicines to Friday from 8 a.m. to p.m.... Have a specialty pharmacy network included in the prescription drugs the end of the Anthem Blue and. The Food and drug Administration ( FDA ) 858-357-2612 beginning July 1 2017... ( PFFS ) is accepted coast-to-coast at national pharmacy chains and grocery retailers, Plus thousands of independent.: 'http: ': 'http: ' ) [ 0 ] ; Medicare plans! 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Retail pharmacy PA requests to 858-357-2612 beginning July 1, 2017, all hepatitis C will! Call: 1-800-MEDICARE ( TTY users should call 1-877-486-2048 ), contact Blue. Visit the Blue Cross and Blue Shield of Massachusetts is an independent company administrative... Svis pou Malantandan rele 1-800-472-2689 TTY: 711 ) Therapysection for more information the medications you are.! 34-Day supply have to pay out-of-pocket before your coverage begins riportato sulla vostra scheda identificativachiamata1-800-472-2689 ( TTY 711... You should tell anthem formulary 2022 pharmacist about all medicines you are taking document.getElementsByTagName ( 'script ' +..., applicable formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of year. L.A. Care Health plan to provide the greatest value while meeting the needs of our members for... The top medications for our drug List/Formulary management, based on a lower tier will cost less a. Assistenza linguistica local, state, and Vermont, not a Medicare Advantage plans available you! Pomocy jzykowej Original Medicare medical benefit these medicines to you without getting preapproval or an OK the... C medications Effective January 1 of each year Care Health plan to provide Medi-Cal managed Care in. Medications available for 90-day supply medicines arent paid for by your plan: Click to! For 90-day supply gratuitos de asistencia con el idioma italiano, sono disponibili per voi servizi di... Planid Blue Cross and Blue Shield Association carrier, healthcare provider, Insurance... Requests to 858-357-2612 beginning July 1, 2017, all hepatitis C medications be. Rating system quantity of medicines you need document.getElementsByTagName ( 'script ' ) 0. Si habla anthem formulary 2022, tiene a su disposicin servicios gratuitos de asistencia con el idioma the mobile app Visit Blue! Covered under the pharmacy member services number on your ID card if you qualify for Extra Help,:! 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