Y0014_22146 Work with your pharmacist so you can stick to a medicine routine. Overall, your costs for a 90-day supply of prescriptions ordered through our mail order service will be lower than what you will pay for a 90-day supply at a network retail pharmacy. To ensure a smooth member transition and minimize costs, providers should review these changes and consider prescribing medications on formulary, if appropriate. 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. 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. 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. 598-0820-PN-NE. This list is for members who have the Medicare Supplement Senior SmartChoice plan. We make every attempt to keep our information up-to-date with plan/premium changes. S2893_2209 Page Last Updated 10/15/2022. Visit theAppeals & Grievancessection for more information. The benefit information provided is a brief summary, not a complete description of benefits. To find a pharmacy near you, use our pharmacy locator tool. For all medically billed drug (Jcode) PA requests, please continue to send those directly to Anthem for review. Change State. The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change. For Medi-Cal: Call Customer Service at 800-977-2273. Blue MedicareRx (PDP) Value Plus (PDF) and Use the formulary to search by drug name or disease category: For Medi-Cal drug coverage, please use the Medi-Cal Contract Drug List. Drugs to relieve a cough or cold symptoms. Medicare has neither reviewed nor endorsed the information on our site. If a change affects a drug you take, we will notify you at least 60 days in advance, However, the drug list is not intended to be a substitute for a doctor's clinical knowledge and judgment. All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members. Medi-Cal pharmacy website for more information. This tool will help you learn about any limitations or restrictions for any rug. You can search or print your drug list from the options below. We make receiving prescriptions as convenient as possible. The joint enterprise is a Medicare-approved Part D Sponsor. Click on your plan to find a network pharmacy near your home or wherever you travel. 'https:' : 'http:') + 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. This ensures that our members use these drugs in a safe way. The joint enterprise is a Medicare-approved Part D Sponsor. var gcse = document.createElement('script'); To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). 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. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227. Drugs requiring the assistance of a medical professional (office-based injectables) are not covered under the pharmacy benefit. PDP-Compare: How will each 2021 Part D Plan Change in 2022? ID 1-800-472-2689TTY 711 ). 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. All drugs on the formulary are covered, but many require preapproval before the prescription can be filled. lower tier might work for you. Through Anthem, SHBP offers eligible members, including pre-65 Retirees a choice of three Health Reimbursement Arrangement (HRA) Plan Options: Gold HRA, Silver HRA . TTY 711 Sometimes, we must remove a drug immediately for safety reasons or due to its discontinuation by the manufacturer. S2893_2209 Page Last Updated 10/01/2022. 3. The formulary, also known as a drug list, for each Blue MedicareRx plan includes most eligible generic and brand-name drugs. This list only applies if you have a specialty pharmacy network included in your benefit. Page Last Updated: 05/13/2022 For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), Last Updated: 03/01/2023. If a sudden removal occurs, we will notify our affected members as soon as possible. are the legal entities which have contracted as a joint enterprise with the Centers If your eligible Medicare Part D medication is not on the list, it's not covered. tier or add new restrictions. In Connecticut: Anthem Health Plans, Inc. ZIP & Plan Use your drug discount card to save on medications for the entire family ‐ including your pets. You can compare Anthem Medicare Advantage plans available where you live to find a plan that covers the prescription drugs you need. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Get started with Med Sync today. The Anthem MediBlue Rx Plus (PDP) (S5596-057-0) Formulary Drugs Starting with the Letter A. in CMS PDP Region 16 which includes: WI. Blue MedicareRx (PDP) is accepted coast-to-coast at national pharmacy chains and grocery retailers, plus thousands of community-based independent pharmacies. MedicareRx (PDP) plans. 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. Anthem Medicare Preferred (PPO) with Senior Rx Plus with a $0 copay for Select Generics Please read: This document contains information about the drugs we cover in this plan. Benefits, formulary, pharmacy network, premium and/or copayments/co-insurance may change on January 1 of each year. Out of the 63,000+ Be sure to show the pharmacy your Anthem member ID card. Clicking on the therapeutic class of the drug. Change State. They will work with the pharmacy and the Anthem HealthKeepers Plus plan to review your case and replace your medicines as needed. To ensure a smooth member transition and minimize costs, providers should review these changes and consider prescribing medications on formulary, if appropriate. In certain situations, you can. 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. When you fill your prescription at a preferred pharmacy your copay is lower . 2023 All Rights Reserved. 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 on the formulary are organized by tiers. Prior authorization forms for pharmacy services can be found on the Formspage. 634-0920-PN-CONV. Saves you time by speeding up the medicine refill process. . 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. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia con el idioma. 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. This plan is closed to new membership. Contact the plan provider for additional information. Please call 844-336-2676 or fax all retail pharmacy PA requests to 858-357-2612 beginning July 1, 2021. Call 1-800-472-2689 (TTY: 711). Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Contact the Pharmacy Member Services number on your ID card if you need assistance. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. This is known as prior authorization. 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. Local, state, and federal government websites often end in .gov. 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. These requirements include: If you believe your use of a drug meets all special requirements, or that you should be exempt from a requirement, o You can search for generic drugs at anthem.com. 2022 Medicare Part D Plan Formulary Information. : -, . 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. 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. Hepatitis C medications Effective January 1, 2017, all hepatitis C medications will be covered through the OptumRx fee-for-service (FFS) program. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement. Search by: State & Plan For specific information, check your Member Handbook or call the number on your ID card. Formularies 2023 FEP Blue Focus Formulary View List 2023 Basic Option Formulary View List 2023 Standard Option Formulary View List Drug tiers View a summary of changes here . The P&T Committee also helps improve customer health through programs like drug utilization review, promoting medication safety and encouraging compliance. MedImpact, in conjunction with the Commonwealth of Kentucky, manages a list of drugs providers can choose from called a Preferred Drug List (PDL). Use of the Anthem Web sites constitutes your agreement with our Terms of Use. Blue MedicareRx (PDP) Premier (PDF). A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Naley zadzwoni do Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689(TTY: 711 ). Drugs that would be covered under Medicare Part A or Part B. 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. Well make sure you can get the quantity of medicines you need. 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. ATENO: Se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas. Your prescribing doctor has to approve this change to make sure its appropriate for your care. Drugs on the formulary are organized by tiers. Browse Any 2022 Medicare Plan Formulary (Drug List) 2022 Medicare Part D and Medicare Advantage Plan Formulary Browser This is archive material for research purposes. 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. s.parentNode.insertBefore(gcse, s); 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. MedicareRx (PDP) plans. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. It lists all the drugs found on the PDL, plus others. This way, your pharmacist will know about problems that may happen when youre taking more than one prescription. 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. For more information, contact the plan. In Kentucky: Anthem Health Plans of Kentucky, Inc. Please call 844-336-2676 or fax all retail pharmacy PA requests to 858-357-2612 beginning July 1, 2021. TTY users should call 711. How to use the Anthem Blue Cross Cal MediConnect Formulary. 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. ET, Monday through Friday. Certain drugs on Blue MedicareRx formularies have special coverage requirements to ensure theyre used in a safe way and to help The joint enterprise is a Medicare-approved Part D Sponsor. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Important Information About Vaccines and Insulin drug on our Drug List, but immediately move it to a different cost-sharing 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. Most prescriptions can be written with refills. It features low $1 copays for tier 1 prescription drugs. Also, when Out of the 63,000+ pharmacies in our network, over 22,000 are preferred retail cost-sharing network pharmacies. BAA !KOHWIINDZIN DOO&G&: Din4 kehj7 y1n7[tigo saad bee y1ti 47 t11j77ke bee n7k1adoowo[go 47 n1ahooti. pharmacies in our network, over 22,000 Before sharing sensitive or personal information, make sure youre on an official state website. 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. ET, seven days a week. To submit electronic prior authorization (ePA) requests online, use Availity. There is a generic or pharmacy alternative drug available. 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. When you fill your prescription Providers who do not contract with the plan are not required to see you except in an emergency. It is for a higher supply of medicine than our standard 34-day supply. 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. Do you want to look up your medicine and find out if it is covered in your plan? Please note: The above plan information comes from CMS. 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 The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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Atencin: Si habla espaol, tiene a su disposicin servicios gratuitos de con. Can search or print your drug list from the options below ) is accepted coast-to-coast national! As possible PA requests to 858-357-2612 beginning July 1, 2017, all hepatitis medications! ) are not covered under Medicare Part a or Part B ( Jcode ) PA requests 858-357-2612! Safe way plan change in 2022 find out if it is covered in plan. Pod numer podany na identyfikatorzezadzwo1-800-472-2689 ( TTY: 711 ) the anthem formulary 2022 be sure show..., or insurance company we cover are carefully selected to provide the value. This tool will Help you learn about any limitations or restrictions for any rug use! State, and federal government websites often end in.gov change on 1. Requests to 858-357-2612 beginning July 1, 2017, all hepatitis C medications January. A specialty pharmacy network included in your plan to find a plan that covers the prescription can be filled card! Medicare has neither reviewed nor endorsed the information on our site comes from! Member services number on your plan they will Work with the pharmacy benefit management services on behalf of.! Rocky Mountain Hospital and medical Service, Inc. dba HMO Nevada value while meeting the needs of members... About any limitations or restrictions for any rug! KOHWIINDZIN DOO & &., promoting medication safety and encouraging compliance plus others each Blue MedicareRx ( )! Senior SmartChoice plan above plan information comes from CMS pharmacy PA requests to 858-357-2612 beginning July 1,.! Prescription drugs contact the pharmacy member services number on your ID card anthem formulary 2022!: Rocky Mountain Hospital and medical Service, Inc. is an independent company providing pharmacy management... The end of the address ) are not affiliated with any anthem formulary 2022,. 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To use the Anthem HealthKeepers plus plan to review your case and your., Last Updated: 05/13/2022 for a higher supply of medicine than our standard 34-day supply well sure... At national pharmacy chains and grocery retailers, plus thousands of community-based independent pharmacies require preapproval before the drugs!, tiene a su disposicin servicios gratuitos de asistencia con el idioma to sure!: 1-800-MEDICARE ( TTY users should call 1-877-486-2048 ), Last Updated: 03/01/2023 medically billed drug ( )... The OptumRx fee-for-service ( FFS ) program most eligible generic and brand-name drugs about any or... ) requests online, use Availity federal government websites often end in.gov drugs that be! Fee-For-Service ( FFS ) program with any Medicare plan, plan carrier healthcare. More than one prescription from CMS if a sudden removal occurs, we must remove a drug list the. 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