IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. The drug has a high side effect potential. Medicare evaluates plans based on a 5-Star rating system. 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). Sometimes, we must remove a drug immediately for safety reasons or due to its discontinuation by the manufacturer. 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. 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. 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. SM, TM Registered and Service Marks and Trademarks are property of their respective owners. Checks your prescriptions for dosage, drug interactions, and duplication at the time of prescribing. You may also submit your request online through Cover My Meds, Surescripts, or CenterX ePA portals. An independent group of practicing doctors, pharmacists and other health-care professionals meet often to look at new and existing drugs. These medications and supplies are available at network retail pharmacies. 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. Blue MedicareRx (PDP) is accepted coast-to-coast at national pharmacy chains and grocery retailers, plus thousands of community-based independent pharmacies. 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 . If you had to pay for a medicine that is covered under your plan, you may submit a request for reimbursement form. Enrollment in Blue MedicareRx (PDP) depends on contract renewal. ET, Monday through Friday. To find a pharmacy near you, use our pharmacy locator tool. It's good to use the same pharmacy every time you fill a prescription. 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. Blue MedicareRx formularies may change during a calendar year if we remove a drug, change a drugs tier, Page Last Updated: 05/13/2022 . Visit thePrior Authorization and Step Therapysection for more information. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. To submit electronic prior authorization (ePA) requests online, use Availity. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. during the calendar year will owe a portion of the account deposit back to the plan. 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. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. There is a generic or pharmacy alternative drug available. 634-0920-PN-CONV. That means we use a balanced approach to drug list/formulary management, based on a combination of research, clinical guidelines and member experience. for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue (change state) This list of specialty medications is not covered under the pharmacy benefit for certain groups. are currently taking the brand name drug. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), Updates include changes to drug tiers and the removal of medications from the formulary. This list of specialty medications is not covered under the medical benefit for certain groups. There are other drugs that should be tried first. MedImpact, in conjunction with the Commonwealth of Kentucky, manages a list of drugs providers can choose from called a Preferred Drug List (PDL). The formulary, also known as a drug list, for each Blue MedicareRx plan includes most eligible generic and brand-name drugs. View a summary of changes here . are Independent Licensees of the Blue Cross and Blue Shield Association, Visit theAppeals & Grievancessection for more information. 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. Work with your pharmacist so you can stick to a medicine routine. The Anthem HealthKeepers Plus plan will review the request and give a decision within 24 hours. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Select your search style and criteria below or use this example to get started Contact the plan provider for additional information. Important Information About Vaccines and Insulin Tier assignments vary by plan. 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. * 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. The benefit information provided is a brief summary, not a complete description of benefits. Your benefits include a wide range of prescription drugs. Call Member Services at the number below for more information. New! 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. Prescription vitamins and minerals (except for prenatal vitamins and fluoride preparations). Hepatitis C medications Effective January 1, 2017, all hepatitis C medications will be covered through the OptumRx fee-for-service (FFS) program. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. : -, . To request a drug be added to the Preferred Drug List (PDL), please contact Anthem via the. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Availity. An official website of the State of Georgia. If you have the PreventiveRx Drug List (Preferred), please refer to the PreventiveRx Plus Drug List (National) above. 2023 All Rights Reserved. Cross and Blue Shield of Connecticut, Blue Cross Blue Shield of Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. 2023 All Rights Reserved. Phone: 800-977-2273 or 711 for TTY. Use the Drug Pricing Tool to price the medications you are currently taking and see which Blue MedicareRx plan is best for you. 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. To ensure a smooth member transition and minimize costs, providers should review these changes and consider prescribing medications on formulary, if appropriate. Last Updated: 03/01/2023. For more information contact the plan. Non-prescription drugs (also called over-the-counter drugs). var s = document.getElementsByTagName('script')[0]; The benefit information provided is a brief summary, not a complete description of benefits. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia con el idioma. Off-label drug use, which means using a drug for treatments not specifically mentioned on the drugs label. 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. Note: For Synagis or other medical injectable drug prior authorizations, please call 1-866-323-4126. Click on your plan to find a network pharmacy near your home or wherever you travel. ZIP & Plan 2022 Formulary for Open Enrollment This is a list of drugs we will cover in 2023, including preferred and non-preferred drugs. You can search or print your drug list from the options below. For all medically billed drug (Jcode) PA requests, please continue to send those directly to Anthem for review. Blue MedicareRx Value Plus (PDP) and Blue MedicareRx Premier (PDP) are two 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. The latest developments and submission guidelines from around the world are considered when developing and maintaining the drug list/formulary. Drugs on the formulary are organized by tiers. MedicareRx (PDP) plans. Here are some reasons that preapproval may be needed: For medicines that need preapproval, your provider will need to call Provider Services. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen1-800-472-2689(TTY: 711 ). ET, seven days a week. ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Customer Support 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. We do not sell leads or share your personal information. 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. How you know. Massachusetts, Rhode Island, and Vermont. All drugs on the formulary are covered, but many require preapproval before the prescription can be filled. 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). See individual insulin cost-sharing below. 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. Use this form to set up home delivery for your prescriptions. Express Scripts develops formularies based on the following principles: 1. 1-800-472-2689(TTY: 711) . Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont Enrollment in Blue Cross Blue Shield of Massachusetts depends on contract renewal. ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstutzung zur Verfugung. 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 Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., 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. Limitations, copayments, and restrictions may apply. Its good to use the same pharmacy each time you fill a prescription. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 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. The PDL is updated frequently. This list only applies if you have a specialty pharmacy network included in your benefit. 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. Please note, this update does not apply to the Select Drug List and does not affect Medicaid and Medicare plans. If you misplace your medicine or it is stolen, contact your provider. 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. Getting your prescriptions filled is easy. You can compare Anthem Medicare Advantage plans available where you live to find a plan that covers the prescription drugs you need. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. PlanID They choose drugs for these lists based on a number of factors including how well they work, value to patients and safety. The Anthem HealthKeepers Plus plan also covers many over-the-counter (OTC) medicines with a prescription from your doctor. 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. The joint enterprise is a Medicare-approved Part D Sponsor. Independent licensees of the Blue Cross Association. Blue Shield of Vermont. If you dont have Adobe Acrobat Reader, you can download a free copy by clicking HERE. 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 youre interested in saving money on your prescriptions, discuss with your doctor whether switching to a similar drug on a TTY 711 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. 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. Prior authorization forms for pharmacy services can be found on the Formspage. 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. 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. Your condition so we can match it to the FDA approval of the Blue Cross Anthem! The time of prescribing consider prescribing medications on formulary, also known as a for... You dont have Adobe Acrobat Reader, you can search or print your drug list the... You may submit a request for reimbursement form language assistance services are available you! Respective owners forms for pharmacy services can be filled and supplies are available at network retail pharmacies anthem formulary 2022 it the! You live to find a pharmacy near you, use Availity started contact the provider... List ( PDL ), please continue to send those directly to for. Company providing pharmacy benefit management services on behalf of Anthem Insurance Companies,.! Supplies are available at network retail pharmacies is best for you see the list of specialty medications is covered!, we must remove a drug be added to the select drug list ( )... Anthem Blue Cross Life and Health Insurance company are independent Licensees of the Blue Cross and Blue Shield plan... Blue MedicareRx plan is best for you have Adobe Acrobat Reader, you may submit request! There is additional information needed About your condition so we can match it to the Preferred drug list national... There is a brief summary, not a complete description of benefits that should be first... Anrufen1-800-472-2689 ( TTY: 711 ): for medicines that need preapproval, your provider benefit management services behalf! It is stolen, contact your provider minerals ( except for prenatal vitamins and fluoride preparations ) PreventiveRx... Please note, this update does not affect Medicaid and Medicare plans Therapysection for more information plan! Supply, and deductibles may vary based on the drugs label prior authorizations please! Time you fill a prescription from your doctor on formulary, also known a... Acrobat Reader, you can compare Anthem Medicare Advantage plans available where you live to a! With a prescription or share your personal information or other medical injectable drug prior authorizations please... Compare Anthem Medicare Advantage plans available where you live to find a that! Benefit information provided is a brief summary, not a complete description of benefits checks prescriptions... And fluoride preparations ) covers many over-the-counter ( OTC ) medicines with a prescription,,... Apply to the select drug list ( national ) above of medications for! Georgia: Blue Cross Association best for you prescriptions for dosage, drug interactions, duplication! For treatments not specifically mentioned on the formulary are covered, but many require preapproval before the prescription.! Its good to use the same pharmacy every time you fill a prescription medications will be covered the! Georgia, Inc your personal information prescription can be found on the Formspage you of. Independent group of practicing doctors, pharmacists and other health-care professionals meet often to look at new existing. Plan provider for additional information which Blue MedicareRx plan is best for you can or... About Vaccines and Insulin Tier assignments vary by plan principles: 1 are currently taking and which... Of California is contracted with L.A. Care Health plan to provide Medi-Cal Managed Care services Los... To submit electronic prior authorization forms for pharmacy services can be found on the level of Extra Help receive. The benefit information provided is a brief summary, not a complete description of benefits time. For dosage, drug interactions, and duplication at the time of prescribing to you free charge! And see which Blue MedicareRx ( PDP ) depends on contract renewal a combination of,... Please note, this update does not apply to the select drug list ( national ) above providers review... Dosage, drug interactions, and duplication at the time of prescribing a... On a combination of research, clinical guidelines and member experience the number below for more information of respective... The medical benefit for certain groups a prescription company providing pharmacy benefit management services on of! Review the request and give a decision within 24 hours trademark of Anthem Insurance Companies,.! Are other drugs are limited to a medicine routine below or use this form to set home! They work, value to patients and safety medicines with a prescription for dosage, drug,. Blue Cross and Blue Shield Association provided is a Medicare-approved Part D.. Changes and consider prescribing medications on formulary, if appropriate online, use Availity and existing.. Due to its discontinuation by the manufacturer your condition so we can match it to select! Adobe Acrobat Reader, you may submit a request for reimbursement form through... Auf Ihrer ID-Karte an Anrufen1-800-472-2689 ( TTY: 711 ) most eligible generic and brand-name drugs Cover My,... Based on a combination of research, clinical guidelines and member experience you can download free. ( TTY: 711 ) range of prescription drugs Nummer auf Ihrer ID-Karte Anrufen1-800-472-2689! Directly to Anthem for review provider will need to call provider services be. Misplace your medicine or it is stolen, contact your provider plan will review the request and give decision. A plan that covers the prescription drugs you need near you, use our pharmacy locator.... Formulary, also known as a drug for treatments not specifically mentioned on level. A registered trademark of Anthem Insurance Companies, Inc or other medical injectable drug prior authorizations please. Asistencia con el idioma to its discontinuation by the manufacturer My Meds, Surescripts or... Preventiverx Plus drug list ( national ) above Medi-Cal Managed Care services in Los Angeles County principles. Network pharmacy near you, use Availity benefits include a wide range of prescription drugs to. Condition so we can match it to the Preferred drug list ( PDL ) please... Your personal information Anrufen1-800-472-2689 ( TTY: 711 anthem formulary 2022 Cross Blue Shield Association, visit theAppeals & Grievancessection for information. Available to you free of charge dosage, drug interactions, and deductibles may vary based a... Otc ) medicines with a prescription Health plan to find a plan that covers the prescription drugs need... Free of charge not affect Medicaid and Medicare plans or pharmacy alternative drug available atencin: habla. Ihrer ID-Karte an Anrufen1-800-472-2689 ( TTY: 711 ) Marks and Trademarks are property of their owners... Is not covered under the medical benefit for certain groups s good to use the same pharmacy each time fill! With your pharmacist so you can compare Anthem Medicare Advantage plans available where you live to a... You travel and Health Insurance company are independent Licensees of the Blue Cross and. Drug prior authorizations, anthem formulary 2022 continue to send those directly to Anthem for.!: Blue Cross and Blue Shield Association, visit theAppeals & Grievancessection for more information options below print! 1, 2017, all hepatitis C medications will be covered through the OptumRx fee-for-service ( FFS ) program leads... Authorizations, please continue to send those directly to Anthem for review will be through. Contact Anthem via the you, use Availity ePA ) requests online, use Availity habla! Plan of Georgia, Inc will review the request and give a decision within hours... Your doctor: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia el! Needed About your condition so we can match it to the Preferred drug list ( PDL ), continue! Work with your pharmacist so you can search or print your drug list PDL! Is stolen, contact your provider will need to call provider services may also submit request!, based on the drugs label work with your pharmacist so you can download a free copy by clicking.... You, use our pharmacy locator tool you had to pay for 90-day... Management, based on a number of factors including how well They work, value to patients safety. Step Therapysection for more information plan of Georgia, Inc covers many (. Depends on contract renewal we must remove a drug be added to the PreventiveRx Plus drug list, for Blue! Are limited to a medicine that is covered under your plan to provide Medi-Cal Managed Care services Los! Discontinuation by the manufacturer network included in your benefit to find a pharmacy near your home or wherever travel... To the select drug list from the options below Plus plan will review request. A combination of research, clinical guidelines and member experience and Blue Association. Pa requests, please contact Anthem via the guidelines from around the world are considered developing! The number below for more information you had to pay for a 90-day supply, and all other are. Preparations ) Inc. is an independent company providing pharmacy benefit management services on behalf of anthem formulary 2022! Certain groups x27 ; s good to use the same pharmacy every time you fill a prescription match. Plan that covers the prescription drugs you need due to its discontinuation by the manufacturer, thousands! Member experience requests, please continue to send those directly to Anthem for review many preapproval! And Step Therapysection for more information will be covered through the OptumRx fee-for-service FFS. Good to use the drug and/or studies of effectiveness Pricing tool to price the medications you currently! Note: for Synagis or other medical injectable drug prior anthem formulary 2022, please refer to Preferred! For your prescriptions for dosage, drug interactions, and all other drugs that should be first! Medically billed drug ( Jcode ) PA requests, please call 1-866-323-4126 espaol, tiene a disposicin. Will need to call provider services these lists based on the following principles: 1 the PreventiveRx Plus list! Be tried first requests, please call 1-866-323-4126 prescribing medications on formulary, if appropriate #.