If a change affects a drug you take, we will notify you at least 60 days in advance, This list of specialty medications is not covered under the medical benefit for certain groups. These requirements include: If you believe your use of a drug meets all special requirements, or that you should be exempt from a requirement, Your benefits include a wide range of prescriptions and over-the-counter (OTC) medicines. covered by Anthem. For specific information, check your Member Handbook or call the number on your ID card. the plan cover a drug that is not included in the formulary. 1-800-472-2689( . . .: 711). For Medi-Cal: Call Customer Service at 800-977-2273. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). To submit electronic prior authorization (ePA) requests online, use Availity. You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. October 1 through March 31, 8:00 a.m. to 8:00 p.m. Benefits, formulary, pharmacy network, premium and/or copayments/co-insurance may change on January 1 of each year. 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. Note: For Synagis or other medical injectable drug prior authorizations, please call 1-866-323-4126. View the upcoming formulary changes for Enrollment in Blue MedicareRx (PDP) depends on contract renewal. With your secure online account, you can: You can have many prescription drugs shipped directly to your home through CarelonRx Home Delivery pharmacy. Blue MedicareRx (PDP) is accepted coast-to-coast at national pharmacy chains and grocery retailers, plus thousands of community-based independent pharmacies. Medicare MSA Plans do not cover prescription drugs. Coverage is available to residents of the service area or members of an employer Search by: State & Plan Registered Marks of Blue Cross and Blue Shield of Massachusetts, Inc., and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. Registered Marks, TM Trademarks. Type at least three letters and we will start finding suggestions for you. MedImpact, in conjunction with the Commonwealth of Kentucky, manages a list of drugs providers can choose from called a Preferred Drug List (PDL). Saves you time by speeding up the medicine refill process. Cross and Blue Shield of Connecticut, Blue Cross Blue Shield of Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. The Anthem HealthKeepers Plus plan also covers many over-the-counter (OTC) medicines with a prescription from your doctor. To request a printed copy of our pharmacy directory call us, 24 hours a day, 7 days a week. as required by Medicare. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). Getting your prescriptions filled is easy. Blue Shield of Vermont. o You can search for generic drugs at anthem.com. Updates include changes to drug tiers and the removal of medications from the formulary. Use of the Anthem Web sites constitutes your agreement with our Terms of Use. This plan covers select insulin pay $35 copay. Its easy when you use our search tool. Do you want to look up your medicine and find out if it is covered in your plan? Our Medication Synchronization program (Med Sync) makes getting all your medicines easier at no extra cost to you. Non-prescription drugs (also called over-the-counter drugs). Bring your member ID card and prescription to a plan pharmacy. 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. When you fill your prescription Select your search style and criteria below or use this example to get started 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. The joint enterprise is a Medicare-approved Part D Sponsor. A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. These kinds of medicines arent paid for by your plan: Click here to see the list of medications available for 90-day supply. S2893_2244 Massachusetts, Rhode Island, and Vermont. Typing the name (at least first three letters) of the drug in the search box. Get started with Med Sync today. TTY users should call 711. There are certain types of drugs that Blue MedicareRx cannot include in the formulary due to federal law, including: In addition, a Medicare Part D plan cannot cover: Blue MedicareRx (PDP) is a Prescription Drug Plan with a Medicare contract. 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. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. ID 1-800-472-2689TTY: 711 . The P&T Committee also helps improve customer health through programs like drug utilization review, promoting medication safety and encouraging compliance. Work with your pharmacist so you can stick to a medicine routine. gcse.src = (document.location.protocol == 'https:' ? ATANSYON: Si ou pale kreyl ayisyen, svis asistans nan lang disponib pou ou gratis. TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult. Your Medicare Part D prescription benefit is a 5-tier structure. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Contact the Pharmacy Member Services number on your ID card if you need assistance. Drugs on the formulary are organized by tiers. Featured In: area. MedicareRx (PDP) plans. Pharmacy services billed as a medical (professional) or institutional claim (or their electronic equivalents) are not in scope. In certain situations, you can. If you dont see your medicine listed on the drug lists, you may ask for an exception at [email protected] 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. Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition. : , , . S2893_2209 Page Last Updated 10/01/2022. or add a special coverage requirement. All drugs on these lists are approved by the Food and Drug Administration (FDA). In Kentucky: Anthem Health Plans of Kentucky, Inc. All prior authorizations will be managed by MedImpact. However, the drug list is not intended to be a substitute for a doctor's clinical knowledge and judgment. To find a pharmacy near you, use our pharmacy locator tool. For more information about tiers, please see yoursummary of benefits. The PDL is updated frequently. Express Scripts develops formularies based on the following principles: 1. 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). You may also submit your request online through Cover My Meds, Surescripts, or CenterX ePA portals. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. View a summary of changes here . Deductible as low as $350 $1 - $5 copays for most generic drugs at preferred pharmacies Select list of covered drugs Mail-order delivery for eligible prescriptions PDP-Compare: How will each 2021 Part D Plan Change in 2022? for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue are the legal entities which have contracted as a joint enterprise with the Centers Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. you and/or your doctor must request a coverage determination before the plan will cover your drug. Some of the links on this page can only be viewed using Adobe Acrobat Reader. Effective January 1, 2022, the Department of Health Care Services (DHCS) will transition all administrative services related to Medi-Cal Managed Care (Medi-Cal) pharmacy benefits billed on pharmacy claims from the existing fee-for-service fiscal intermediary (FI) under Medi-Cal or the members managed care plan to DHCS new pharmacy vendor/FI for Medi-Cal, Magellan Medicaid Administration, Inc. (Magellan). Blue MedicareRx Value Plus (PDP) and Blue MedicareRx Premier (PDP) are two If you need more medicine than the standard 34-day supply to treat a condition, you can ask us for prior authorization. at a preferred pharmacy your copay is lower than what you would pay at a standard network pharmacy. Please note, this update does not apply to the Select Drug List and does not affect Medicaid and Medicare plans. Some medicines need a preapproval or an OK from the Anthem HealthKeepers Plus plan before your provider can prescribe them. Blue MedicareRx Value Plus (PDP) and Blue MedicareRx Premier (PDP) are two The formulary is a list of our covered prescription drugs, including generic, brand name and specialty drugs. ET, Monday through Friday. An official website of the State of Georgia. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Call to speak with a licensed insurance agent and find plans in your area. Member Service 1-800-472-2689(TTY: 711). Quantity supply limits and dose optimization, Visit the Centers for Medicare & Medicaid Services website for the latest news on the e-Rx Incentive Program, Assistive Devices and Walker/Wheelchair Accessories, Privacy Guidance When Selecting Third-Party Apps, Privacy Guidance When Selecting Third-Party Apps - Spanish. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 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. Updates include changes to drug tiers and the removal of medications from the formulary. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. We rely on objective evaluations from independent physicians. Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont We do not sell leads or share your personal information. This group meets regularly to review new and existing drugs, and to choose the top medications for our Drug List/Formulary. : -, . Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen1-800-472-2689(TTY: 711 ). Off-label drug use, which means using a drug for treatments not specifically mentioned on the drugs label. We work with CarelonRx to provide these pharmacy benefits. 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. We offer an outcomes-based formulary. If you had to pay for a medicine that is covered under your plan, you may submit a request for reimbursement form. To conduct a search, enter the Medication Name or select a Therapeutic Category or TherapeuticClass. Enrollment in Blue MedicareRx (PDP) depends on contract renewal. Products & Programs / Pharmacy. 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. 2. Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont var gcse = document.createElement('script'); lower tier might work for you. Our. To request a printed copy of our pharmacy directory call us, 24 hours a day, 7 days a week. Call 1-800-901-0020 (TTY 711). An independent group of practicing doctors, pharmacists and other health-care professionals meet often to look at new and existing drugs. 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. The Anthem MediBlue Rx Plus (PDP) (S5596-057-0) Formulary Drugs Starting with the Letter A. in CMS PDP Region 16 which includes: WI. If you like the convenience of having your prescription drugs delivered, you may utilize the CVS Caremark Mail-order pharmacy. This tool will help you learn about any limitations or restrictions for any rug. Sep 1, 2020 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). It lists all the drugs found on the PDL, plus others. 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. For all medically billed drug (Jcode) PA requests, please continue to send those directly to Anthem for review. For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. Our primary concern is clinical appropriateness, not drug cost. Be sure to show the pharmacy your Anthem member ID card. Here are some reasons that preapproval may be needed: For medicines that need preapproval, your provider will need to call Provider Services. These lists may be for you if you refill prescriptions through home delivery or at a Rx Maintenance 90 pharmacy for maintenance drugs, which are used to treat long-term conditions like high blood pressure or diabetes. Please call 844-336-2676 or fax all retail pharmacy PA requests to 858-357-2612 beginning July 1, 2021. For more recent information or other questions, please contact Customer Care at 1-844-345-4577, 24 hours a day, 7 days a week. In Maine: Anthem Health Plans of Maine, Inc. 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). Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. (ID Card) 1-800-472-2689(TTY: 711 ). Using the A to Z list to search by the first letter of your drug. Plus, you have access to up-to-date coverage information in your drug list, including details about brands and generics, dosage/strength options, and information about prior authorization of your drug. ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. MedicareRx (PDP) plans. We partner with CarelonRx Specialty Pharmacy and AcariaHealth to meet all your specialty medication needs. 2022 Medicare Part D Plan Formulary Information. are Independent Licensees of the Blue Cross and Blue Shield Association, Drugs for cosmetic purposes or hair growth. Important Message About What You Pay for Insulin - You wont pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier its on even if you havent paid your deductible, if applicable. Well make sure you can get the quantity of medicines you need. 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. 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. In Indiana: Anthem Insurance Companies, Inc. The preapproval process helps us make sure that youre taking medications safely and correctly. These medications and supplies are available at network retail pharmacies. Blue MedicareRx (PDP) Premier (PDF). Sep 1, 2022 Products & Programs / Pharmacy Effective with dates of service on and after October 1, 2022, and in accordance with the IngenioRx* Pharmacy and Therapeutics (P&T) process, Anthem Blue Cross and Blue Shield will update its drug lists that support Commercial health plans. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. 2023 All Rights Reserved. Providers who do not contract with the plan are not required to see you except in an emergency. TTY users should call, 1-800-325-0778; or your state Medicaid Office. Please note, this update does not apply to the Select Drug List and does not impact Medicaid and Medicare plans. 598-0820-PN-NE. You can also request that , 1-800-472-2689(: 711 ). lancets, test strips). TTY 711 Learn more about Medicare formularies and find an Anthem Medicare Advantage Plan available near you that offers prescription drug coverage. Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at, Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the. This ensures that our members use these drugs in a safe way. Visit theAppeals & Grievancessection for more information. If youre interested in saving money on your prescriptions, discuss with your doctor whether switching to a similar drug on a are currently taking the brand name drug. Find an Anthem Medicare Advantage plan that offers prescription drug coverage. This is known as prior authorization. An official website of the State of Georgia. Note: Not all prescriptions are available at mail order. We are an independent education, research, and technology company. To submit electronic prior authorization (ePA) requests online, use Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. var s = document.getElementsByTagName('script')[0]; Medallion Medicaid/FAMIS: 1-800-901-0020 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. are Independent Licensees of the Blue Cross and Blue Shield Association, The latest developments and submission guidelines from around the world are considered when developing and maintaining the drug list/formulary. Drugs not approved by the U.S. Food and Drug Administration (FDA). Your doctor can prescribe most of these medicines to you without getting preapproval or an OK from us. This version of the Select Drug List applies to Individual plans if you purchased a plan on your state or federal Health Insurance Marketplace (also known as the exchange) or if you purchased coverage off the exchange and not through your employer: 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. Use the Drug Pricing Tool to price the medications you are currently taking and see which Blue MedicareRx plan is best for you. : Nu quy v n.i Ting Vit, c.c dch v h tr ng.n ng c cung cp cho quy v min ph.. Gi cho Dch v Hi vi.n theo s tr.n th ID ca quy v Cuc gi 1-800-472-2689(TTY: 711 ). See how we help keep your out-of-pocket costs low for the medications you and your family need. Drugs for treatment of sexual or erectile dysfunction (ED). 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 Generic Premium Drug List is no longer actively marketed and only applies to members who have not been transitioned to an alternative drug list. lower cost sharing tier and with the same or fewer restrictions. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. Formularies 2023 FEP Blue Focus Formulary View List 2023 Basic Option Formulary View List 2023 Standard Option Formulary View List Drug tiers Also, when There is a generic or pharmacy alternative drug available. There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Contact the plan provider for additional information. Change State. Click here to see the list of medications available for a 90-day supply, and all other drugs are limited to a 34-day supply. If you don't see your medicine listed on the drug lists, you may ask for an exception at [email protected] or by calling Pharmacy Member Services at 833-207-3120. If a sudden removal occurs, we will notify our affected members as soon as possible. If you have the PreventiveRx Drug List (Preferred), please refer to the PreventiveRx Plus Drug List (National) above. S2893_2209 Page Last Updated 10/15/2022. . That means we use a balanced approach to drug list/formulary management, based on a combination of research, clinical guidelines and member experience. If you have the Traditional Open formulary/drug list, this PreventiveRx drug list may apply to you: For PreventiveRx Plus and if you have the Select formulary/drug list, this PreventiveRx Plus drug list may apply to you: For Legacy PreventiveRx Plus 2016 and if you have the Select formulary/drug list, this PreventiveRx Plus drug list may apply to you: This list includes the specialty drugs that must be filled through a participating specialty pharmacy in order for coverage to be provided. In Connecticut: Anthem Health Plans, Inc. OTC drugs aren't shown on the list. adding the new generic drug, we may decide to keep the brand name Drugs to relieve a cough or cold symptoms. Effective with dates of service on and after October 1, 2022, and in accordance with the IngenioRx* Pharmacy and Therapeutics (P&T) process, Anthem Blue Cross and Blue Shield will update its drug lists that support Commercial health plans. 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). ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement. ATENO: Se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas. Phone: 800-977-2273 or 711 for TTY. '//cse.google.com/cse.js?cx=' + cx; The drug is prescribed at a higher dosage than recommended. There is additional information needed about your condition so we can match it to the FDA approval of the drug and/or studies of effectiveness. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members. Call us, 24 hours a day/ 7 days a week or consult plan cover a drug for not... 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