anthem formulary 2022
Contact the Medicare plan for more information. Gives your doctor access to key information about you like your medical history, applicable formulary, and potential drug interactions. 1-800-472-2689(TTY: 711) . This list of specialty medications is not covered under the pharmacy benefit for certain groups. Medicare evaluates plans based on a 5-Star rating system. To request a drug be added to the Preferred Drug List (PDL), please contact Anthem via the. : 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 ). Customer Support Featured In: If a sudden removal occurs, we will notify our affected members as soon as possible. Type at least three letters and well start finding suggestions for you. Local, state, and federal government websites often end in .gov. Make sure you have your medicines when you need them. 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. Certain generic drugs that are available at the lowest copayment for our members, Higher cost generic drugs available at a higher copayment than Tier 1 generic drugs, Common brand-name and some higher cost generic drugs, High cost generic and non-preferred drugs, many of which may have lower cost options available on Tier 1, 2 or 3, Unique and/or very high-cost brand and some generic drugs of which you pay a percentage of the drug cost; some may require special handling and/or close monitoring, Prior authorization you will need to obtain approval before you fill your prescription, Quantity limit There is a limit to the amount of the drug the plan will cover with each prescription filled, Step therapy You may be required to try an alternative drug before this drug is covered, Limited access This prescription may be available only at certain pharmacies. The changes apply for only new prescriptions; members with existing prescriptions for these medications will not be impacted. All drugs on these lists are approved by the Food and Drug Administration (FDA). When you fill your prescription 1-800-472-2689(TTY: 711). 3. Your doctor can prescribe most of these medicines to you without getting preapproval or an OK from us. are replacing it with a new generic drug that will appear on the same or Massachusetts, Blue Cross & Blue Shield of Rhode Island, and Blue Cross and To get Nevada Medicaid benefits through Anthem, you must have limited income and live in one of our service areas. Limitations, copayments, and restrictions may apply. All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members. Medallion Medicaid/FAMIS: 1-800-901-0020 You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 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). Featured In: September 2020 Anthem Blue . Your Medicare Part D prescription benefit is a 5-tier structure. Work with your pharmacist so you can stick to a medicine routine. pharmacies in our network, over 22,000 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. gcse.type = 'text/javascript'; D77 bee an7tah7g7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689(TTY: 711). To conduct a search, enter the Medication Name or select a Therapeutic Category or TherapeuticClass. We are not compensated for Medicare plan enrollments. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Anthem Blue Cross and Blue Shield Medicaid (Anthem) will administer pharmacy benefits for enrolled members. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen1-800-472-2689(TTY: 711 ). However, the drug list is not intended to be a substitute for a doctor's clinical knowledge and judgment. the plan cover a drug that is not included in the formulary. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. Members may enroll in a Medicare Advantage plan only during specific times of the year. A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. MedImpact, in conjunction with the Commonwealth of Kentucky, manages a list of drugs providers can choose from called a Preferred Drug List (PDL). Please direct FFS PA requests and PDL-related questions about hepatitis C drugs to the OptumRx Clinical and Technical Help Desk at 1-855-577-6317. For MRMIP and MMP: Prescriptions can be filled at more than 5,000 retail pharmacies in California and a listing of these pharmacies (pharmacy network) can be found in our provider directories. It is for a higher supply of medicine than our standard 34-day supply. lancets, test strips). * 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. There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. covered by Anthem. Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin llamada 1-800-472-2689 (TTY: 711 ). Your benefits include a wide range of prescription drugs. There is no pharmacy copay for Cardinal Care and FAMIS members.. Star Ratings are calculated each year and may change from one year to the next. Call to speak with a licensed insurance agent and find plans in your area. If you have any questions about your pharmacy benefits, call Pharmacy Member Services at 1-833-207-3120 (TTY 711) 24 hours a day, seven days a week. : -, . Out of the 63,000+ This list only applies if you have a specialty pharmacy network included in your benefit. These kinds of medicines arent paid for by your plan: Click here to see the list of medications available for 90-day supply. Call 1-800-901-0020 (TTY 711). 634-0920-PN-CONV. Appelez le Service adhrents au numro indiqu sur votre carte dassur appel1-800-472-2689 (TTY : 711 ). (change state) The Blue Cross name and symbol are registered marks of the Blue Cross Association , Essential Drug List 3-Tier with 1a/1b (Searchable), Essential Drug List 4-Tier with 1a/1b (Searchable), Essential Drug List 5-Tier with 1a/1b (Searchable), National Drug List 3-Tier with 1a/1b (Searchable), National Drug List 4-Tier with 1a/1b (Searchable), National Drug List 5-Tier with 1a/1b (Searchable), National Direct Drug List 3-Tier (Searchable), National Direct Drug List 3-Tier with 1a/1b (Searchable, National Direct Drug List 4-Tier (Searchable), National Direct Drug List 4-Tier with 1a/1b (Searchable), National Direct Drug List 5-Tier (Searchable), National Direct Drug List 5-Tier with 1a/1b (Searchable), National Direct Drug List 3-Tier with 1a/1b (Searchable), Traditional Open Drug List 3-tier (Searchable), Traditional Open Drug List 3-tier with 1a/1b (Searchable), Traditional Open Drug List 4-tier (Searchable), Traditional Open Drug List 4-tier with 1a/1b (Searchable), Traditional Open Drug List 5-tier (Searchable), Traditional Open Drug List 5-tier with 1a/1b (Searchable), PreventiveRx Plus Drug List (Traditional Open), Legacy PreventiveRx Plus Drug List (Traditional Open), Legacy PreventiveRx Plus Drug List (Select), Specialty drugs not covered under the pharmacy benefit, Specialty drugs not covered under the medical benefit, Home Delivery and Rx Maintenance 90 Drug List, ACA Contraceptive for Religious Affiliate Groups. We are an independent education, research, and technology company. Last Updated: 03/01/2023. Anthem Blue Cross is the trade name of Blue Cross of California. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. 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 Use of the Anthem websites constitutes your agreement with our Terms of Use. Sep 1, 2022 To ensure a smooth member transition and minimize costs, providers should review these changes and consider prescribing medications on formulary, if appropriate. Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont Call Member Services at the number below for more information. Certain drugs on Blue MedicareRx formularies have special coverage requirements to ensure theyre used in a safe way and to help They will work with the pharmacy and the Anthem HealthKeepers Plus plan to review your case and replace your medicines as needed. Page Last Updated: 05/13/2022 If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan. We rely on objective evaluations from independent physicians. We make receiving prescriptions as convenient as possible. 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. This list of specialty medications is not covered under the medical benefit for certain groups. Click on your plan to find a network pharmacy near your home or wherever you travel. Drugs to relieve a cough or cold symptoms. In Kentucky: Anthem Health Plans of Kentucky, Inc. Browse Any 2022 Medicare Plan Formulary (Drug List), 2022 Medicare Part D and Medicare Advantage Plan Formulary Browser, Find a 2023 Medicare Advantage Plan (Health and Health w/Rx Plans), Browse Any 2023 Medicare Plan Formulary (or Drug List), Q1Rx Drug-Finder: Compare Drug Cost Across all 2023 Medicare Plans, Find Medicare plans covering your prescriptions, Medicare plan quality and CMS Star Ratings, Understanding Your Explanation of Benefits, IRMAA: Higher premiums for higher incomes, 2023 Medicare Advantage Plans State Overview, 2023 Medicare Advantage Plan Benefit Details, Find a 2023 Medicare Advantage Plan by Drug Costs. Do not sell or share my personal information. Clicking on the therapeutic class of the drug. lower cost sharing tier and with the same or fewer restrictions. are currently taking the brand name drug. Most prescriptions can be written with refills. The plan deposits Drugs not approved by the U.S. Food and Drug Administration (FDA). These requirements include: If you believe your use of a drug meets all special requirements, or that you should be exempt from a requirement, Please contact the plan for further details. This plan covers select insulin pay $35 copay. drug on our Drug List, but immediately move it to a different cost-sharing Our Medication Synchronization program (Med Sync) makes getting all your medicines easier at no extra cost to you. Contact the plan provider for additional information. Customer Support The PDL is updated frequently. Medi-Cal pharmacy website for more information. 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. We work with CarelonRx to provide these pharmacy benefits. Hours: Monday to Friday from 8 a.m. to 7 p.m. Eastern time. tier or add new restrictions. Call 1-800-472-2689 (TTY: 711). Visit theAppeals & Grievancessection for more information. 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. LU . control costs. ATENO: Se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas. 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. Blue MedicareRx (PDP) is accepted coast-to-coast at national pharmacy chains and grocery retailers, plus thousands of community-based independent pharmacies. 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. Formularies 2023 FEP Blue Focus Formulary View List 2023 Basic Option Formulary View List 2023 Standard Option Formulary View List Drug tiers If a change affects a drug you take, we will notify you at least 60 days in advance, ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstutzung zur Verfugung. The formulary, also known as a drug list, for each Blue MedicareRx plan includes most eligible generic and brand-name drugs. Blue Shield of Vermont. If you like the convenience of having your prescription drugs delivered, you may utilize the CVS Caremark Mail-order pharmacy. Generally, a drug on a lower tier will cost less than a drug on a higher tier. Products & Programs / Pharmacy. gcse.src = (document.location.protocol == 'https:' ? gcse.async = true; Sometimes, we must remove a drug immediately for safety reasons or due to its discontinuation by the manufacturer. Independent licensees of the Blue Cross Association. Saves you time by speeding up the medicine refill process. The latest developments and submission guidelines from around the world are considered when developing and maintaining the drug list/formulary. Cross and Blue Shield of Connecticut, Blue Cross Blue Shield of 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). 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. 2023 All Rights Reserved. and SM Service Marks are the property of their respective owners. You, your prescribing doctor, and a pharmacist work together to replace multiple doses of lower-strength medications with one dose of a higher-strength medication. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. In Indiana: Anthem Insurance Companies, Inc. For specific information, check your Member Handbook or call the number on your ID card. ID 1-800-472-2689TTY: 711 . . You can compare Anthem Medicare Advantage plans available where you live to find a plan that covers the prescription drugs you need. Drugs on the formulary are organized by tiers. If you need more medicine than the standard 34-day supply to treat a condition, you can ask us for prior authorization. ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Independent licensees of the Blue Cross and Blue Shield Association. Updates include changes to drug tiers and the removal of medications from the formulary. To submit electronic prior authorization (ePA) requests online, use Availity. Also, displayed are some medications and supplies covered under your Part B of Original Medicare medical benefit. SM, TM Registered and Service Marks and Trademarks are property of their respective owners. However, they do not qualify for exception requests, extra help on drug costs,transition fills, or accumulate toward your total out of pocket costs to bring you through the coverage gap faster like drugs covered under your Medicare prescription drug benefit. Med Sync helps get your refills on the same schedule so you can pick up most of your medicines on just one day each month. The Anthem HealthKeepers Plus plan will review the request and give a decision within 24 hours. If you have a complex or chronic health condition that requires special medicine, you can get the medicine you need. The joint enterprise is a Medicare-approved Part D Sponsor. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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. 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. That way, your pharmacists will know about problems that could occur when you're . or union group and separately issued by one of the following plans: Anthem Blue 'https:' : 'http:') + Those who disenroll The preapproval process helps us make sure that youre taking medications safely and correctly. 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. Phone: 800-977-2273 or 711 for TTY. Enrollment in Blue MedicareRx (PDP) depends on contract renewal. Drugs that would be covered under Medicare Part A or Part B. Please note: The above plan information comes from CMS. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. To verify Medi-Cal pharmacy network participation or pharmacy drug coverage under Medi-Cal, please call the Pharmacy Benefits Manager: The Anthem Blue Cross Cal MediConnect Plan Formulary lists the brand name or generic name of a given drug. Providers who do not contract with the plan are not required to see you except in an emergency. Attention Members: You can now view plan benefit documents online. 1-800-472-2689( . . .: 711). ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Visit the Limitations, copayments, and restrictions may apply. or add a special coverage requirement. To find a pharmacy near you, use our pharmacy locator tool. All prior authorizations will be managed by MedImpact. Telefone para os Servios aos Membros, atravs do nmero no seu carto ID chamar 1-800-472-2689 (TTY: 711 ). Off-label drug use, which means using a drug for treatments not specifically mentioned on the drugs label. Also, when : , , . 2022 Medicare Part D Plan Formulary Information. Typing the name (at least first three letters) of the drug in the search box. 24 hours a day/7 days a week or consult, When enrolling in a Medicare Advantage plan, you must continue to pay your. : . Small Group 2023 Select Drug List (Searchable) | (PDF) Small Group 2022 Select Drug List (Searchable) | (PDF) Espaol. (change state) 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. New! Contact Anthem Blue Cross and Blue Shield. An official website of the State of Georgia. Change State. Dietary supplements, except for treatment of phenylketonuria (PKU). Select your search style and criteria below or use this example to get started Coverage is available to residents of the service area or members of an employer Please see PDPFinder.com or MAFinder.com for current 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). They choose drugs for these lists based on a number of factors including how well they work, value to patients and safety. Massachusetts, Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Please call 844-336-2676 or fax all retail pharmacy PA requests to 858-357-2612 beginning July 1, 2021. Compare plans What is a Medicare plan drug formulary? We may not tell you in advance before we make that change-even if you The PDL includes all medications covered by Medicaid, including some over-the-counter drugs. 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). 2023 Medicare HMO Blue Formulary. 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. 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. 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. ID 1-800-472-2689TTY 711 ). Benefits, formulary, pharmacy network, premium and/or copayments/co-insurance may change on January 1 of each year. We may immediately remove a brand name drug on our Drug List if we To request a printed copy of our pharmacy directory call us, 24 hours a day, 7 days a week. View a summary of changes here . With your secure online account, you can: You can have many prescription drugs shipped directly to your home through CarelonRx Home Delivery pharmacy. Some medicines need a preapproval or an OK from the Anthem HealthKeepers Plus plan before your provider can prescribe them. 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. View a summary of changes here . We do not sell leads or share your personal information. Member Service 1-800-472-2689(TTY: 711). If prior authorization is required, providers must get approval from MedImpact before a prescription can be filled. 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. Sep 1, 2020 Blue Shield of Vermont. Providers may need to get approval from MedImpact for certain drugs. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. FormularyID, (Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2022 ). 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. Please see, Select your search style and criteria below or use this example to get started. lower tier might work for you. Compare Anthem Part D Plans MediBlue Rx* Standard Part D Plan This plan is a good choice if you take fewer medications. Dose optimization, or dose consolidation, helps you stick with your medicine routine. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia con el idioma. How you know. For more information contact the plan. Through Anthem, SHBP offers eligible members, including pre-65 Retirees a choice of three Health Reimbursement Arrangement (HRA) Plan Options: Gold HRA, Silver HRA . Medicare MSA Plans do not cover prescription drugs. Drugs on the formulary are organized by tiers. 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. Find an Anthem Medicare Advantage plan that offers prescription drug coverage. The formulary, also known as a drug list, for each Blue MedicareRx plan includes most eligible generic and brand-name drugs. Generic drugs have the same active ingredient formula as a brand name drug. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689(TTY: 711 ). 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). Pharmacy services billed as a medical (professional) or institutional claim (or their electronic equivalents) are not in scope.