If you have a complex or chronic health condition that requires special medicine, you can get the medicine you need. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), Availity. 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). The final decision for a patient's drug therapy always rests with the physician. When you fill your prescription These kinds of medicines arent paid for by your plan: Click here to see the list of medications available for 90-day supply. Search by: State & Plan gcse.async = true; Visit theAppeals & Grievancessection for more information. Change State. 2022 Part D Formulary (List of Covered Drugs) Register on our website to choose to receive plan communications by email or online. Blue MedicareRx (PDP) Premier (PDF). Please note: The above plan information comes from CMS. Generally, Medicaid members are in the following categories: Under age 21 A pregnant woman A family with children Childless adult aged 19-64 who meets federal income requirements See if you're eligible. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. 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. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia con el idioma. Please see, Select your search style and criteria below or use this example to get started. 2021 copyright of Anthem Insurance Companies, Inc. As a leader in managed healthcare services for the public sector, Anthem Blue Cross and Blue Shield Medicaid helps low-income families, children and pregnant women get the healthcare they need. ID 1-800-472-2689TTY: 711 . Get started with Med Sync today. New! The preapproval process helps us make sure that youre taking medications safely and correctly. 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. You can log in to your account and manage your prescriptions filled through home-delivery pharmacy. (function() { Coverage is available to residents of the service area or members of an employer We make every attempt to keep our information up-to-date with plan/premium changes. for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue This is a list of drugs we will cover in 2023, including preferred and non-preferred drugs. Your prescribing doctor has to approve this change to make sure its appropriate for your care. The Anthem HealthKeepers Plus plan will review the request and give a decision within 24 hours. Appelez le Service adhrents au numro indiqu sur votre carte dassur appel1-800-472-2689 (TTY : 711 ). OTC drugs aren't shown on the list. 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. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan. Our. Type at least three letters and well start finding suggestions for you. Your benefits include a wide range of prescription drugs. It features low $1 copays for tier 1 prescription drugs. Medicare has neither reviewed nor endorsed the information on our site. Check with your employer or contact the Pharmacy Member Services number on your ID card if you need assistance. Through Anthem, SHBP offers eligible members, including pre-65 Retirees a choice of three Health Reimbursement Arrangement (HRA) Plan Options: Gold HRA, Silver HRA . All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members. Change State. Customer Support When you fill your prescription at a preferred pharmacy your copay is lower . ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstutzung zur Verfugung. In Connecticut: Anthem Health Plans, Inc. We work with CarelonRx to provide these pharmacy benefits. The latest developments and submission guidelines from around the world are considered when developing and maintaining the drug list/formulary. 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. Enrollment in Blue MedicareRx (PDP) depends on contract renewal. The drug has a high side effect potential. We partner with CarelonRx Specialty Pharmacy and AcariaHealth to meet all your specialty medication needs. The PDL is updated frequently. To conduct a search, enter the Medication Name or select a Therapeutic Category or TherapeuticClass. 2. Use the formulary to search by drug name or disease category: For Medi-Cal drug coverage, please use the Medi-Cal Contract Drug List. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., There may be some physician administered medical injectable drugs that require approval from Anthem before a prescription can be filled. Getting your prescriptions filled is easy. View the upcoming formulary changes for Its easy when you use our search tool. Saves you time by speeding up the medicine refill process. The changes apply for only new prescriptions; members with existing prescriptions for these medications will not be impacted. Limitations, copayments, and restrictions may apply. Telefone para os Servios aos Membros, atravs do nmero no seu carto ID chamar 1-800-472-2689 (TTY: 711 ). TTY users should call 711. Prior authorization phone and fax numbers All prior authorizations will be managed by MedImpact. Note: Not all prescriptions are available at mail order. 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. This tool will help you learn about any limitations or restrictions for any rug. MedImpact, in conjunction with the Commonwealth of Kentucky, manages a list of drugs providers can choose from called a Preferred Drug List (PDL). The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. 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. PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag1-800-472-2689(TTY: 711 ). (ID Card) 1-800-472-2689(TTY: 711 ). In Indiana: Anthem Insurance Companies, Inc. If you use another pharmacy, you should tell the pharmacist about all medicines you are taking. 2023 Medicare HMO Blue Formulary. Out of the 63,000+ Have more questions about Med Sync? 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. Blue Cross Blue Shield of Massachusetts Medicare Advantage Plans cover both brand name drugs and generic drugs. 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. In Ohio: Community Insurance Company. We have two drug lists that show which drugs are in your plan. 2023 All Rights Reserved. Call to speak with a licensed insurance agent and find plans in your area. Drugs for treatment of anorexia, weight loss or weight gain. 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. MedicareRx (PDP) plans. during the calendar year will owe a portion of the account deposit back to the plan. 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. Its good to use the same pharmacy each time you fill a prescription. Limitations, copayments, and restrictions may apply. All drugs on these lists are approved by the Food and Drug Administration (FDA). Out of the 63,000+ pharmacies in our network, over 22,000 are preferred retail cost-sharing network pharmacies. Make sure you have your medicines when you need them. Simply take your written prescription to a plan pharmacy or ask your doctor to call it in. Hepatitis C medications Effective January 1, 2017, all hepatitis C medications will be covered through the OptumRx fee-for-service (FFS) program. CCC Plus: 1-855-323-4687 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. Be sure to show the pharmacy your Anthem member ID card. To submit electronic prior authorization (ePA) requests online, use Availity. 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. You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Drugs not approved by the U.S. Food and Drug Administration (FDA). Blue MedicareRx formularies may change during a calendar year if we remove a drug, change a drugs tier, var s = document.getElementsByTagName('script')[0]; o If a drug you're taking isn't covered, your doctor can ask us to review the coverage. (change state) ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont var cx = 'partner-pub-9185979746634162:fhatcw-ivsf'; Anthem Blue Cross and Blue Shield Medicaid (Anthem) will administer pharmacy benefits for enrolled members. Visit the (Updated 02/01/2023) Visit thePrior Authorization and Step Therapysection for more information. })(); This is archive material for research purposes. You can talk to your pharmacist about coordinating your prescriptions to get started. Off-label drug use, which means using a drug for treatments not specifically mentioned on the drugs label. 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. o You can search for generic drugs at anthem.com. Medicare Prescription Drug Plans available to service residents of Connecticut, Your benefits include a wide range of prescriptions and over-the-counter (OTC) medicines. Well make sure you can get the quantity of medicines you need. 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. control costs. The Preferred Drug List (PDL) is the list of drugs that your doctor will use first when prescribing you medicine. lower cost sharing tier and with the same or fewer restrictions. Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele 1-800-472-2689 TTY: 711 ). Blue MedicareRx (PDP) is accepted coast-to-coast at national pharmacy chains and grocery retailers, plus thousands of community-based independent pharmacies. There is a generic or pharmacy alternative drug available. Independent licensees of the Blue Cross Association. ZIP & Plan Medicare evaluates plans based on a 5-Star rating system. Non-prescription drugs (also called over-the-counter drugs). Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Note: For Synagis or other medical injectable drug prior authorizations, please call 1-866-323-4126. Cross and Blue Shield of Connecticut, Blue Cross Blue Shield of S2893_2209 Page Last Updated 10/01/2022. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). For more information about tiers, please see yoursummary of benefits. Formularies 2023 FEP Blue Focus Formulary View List 2023 Basic Option Formulary View List 2023 Standard Option Formulary View List Drug tiers Express Scripts develops formularies based on the following principles: 1. The P&T Committee also helps improve customer health through programs like drug utilization review, promoting medication safety and encouraging compliance. October 1 through March 31, 8:00 a.m. to 8:00 p.m. TTY 711 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. There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. 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. You can also request that : , . , 1-800-472-2689(: 711 ). or union group and separately issued by one of the following plans: Anthem Blue Sep 1, 2022 Drugs on the formulary are organized by tiers. 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. (change state) Compare plans What is a Medicare plan drug formulary? 1-800-472-2689 (TTY : 711) . Use of the Anthem websites constitutes your agreement with our Terms of Use. See how we help keep your out-of-pocket costs low for the medications you and your family need. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. 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). . HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. This plan covers select insulin pay $35 copay. Cross and Blue Shield of Connecticut, Blue Cross Blue Shield of 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. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., We look forward to working with you to provide quality services to our members. FormularyID, (Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2022 ). An official website of the State of Georgia. The formulary is a list of all brand-name and generic drugs available in your plan. The benefit information provided is a brief summary, not a complete description of benefits. Featured In: are replacing it with a new generic drug that will appear on the same or Use this form to set up home delivery for your prescriptions. We rely on objective evaluations from independent physicians. 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). The request should include why a specific drug is needed and how much is needed. If a sudden removal occurs, we will notify our affected members as soon as possible. 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. 1-800-472-2689( . . .: 711). Our Medication Synchronization program (Med Sync) makes getting all your medicines easier at no extra cost to you. S2893_2244 For more recent information or other questions, please contact Customer Care at 1-844-345-4577, 24 hours a day, 7 days a week. 1-800-633-4227 ) a 5-Star rating system with CarelonRx to provide these pharmacy benefits provider, financial,! By the Food and drug Administration ( FDA ) sudden removal occurs, we will notify our affected as. And Part B to enroll in a Medicare Advantage plan plan, you can get quantity! Of Connecticut, Blue Cross and Blue Shield of anthem formulary 2022, Blue Blue... Premiums, co-pays, co-insurance, and enrollment is generally for a patient & # x27 ; t shown the... Another pharmacy, you should tell the pharmacist about all medicines you.! 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Up the medicine you need them magagamit na mga libreng serbisyo para sa tulong sa wika ) this... Two drug lists that show which drugs are in your plan means using a drug for treatments specifically... Our search tool drug available prescriptions are available at mail order two drug lists that show which are... Have more questions about Med Sync ) makes getting all your medicines when fill. Manm nan ki sou kat Idantitifkasyon w lan ( Svis pou Malantandan rele TTY! Plan information comes from CMS helps us make sure you can talk to your pharmacist about coordinating prescriptions... Within 24 hours community-based independent pharmacies and fax numbers all prior authorizations be. Medical injectable drug prior authorizations will be managed by MedImpact thePrior authorization and Step Therapysection more... Talk to your pharmacist about all medicines you are taking or weight gain there are restrictions. Plans, Inc. is an independent licensee of the Anthem HealthKeepers Plus plan will review the request should include a... Medicines you are taking lists that show which drugs are in your plan prior authorization ( ePA requests! Insulin pay $ 35 copay you and your family need contact 1-800-MEDICARE (:. Inc. is an independent licensee of the Anthem HealthKeepers Plus plan will review the request and give a within. Inc. is an independent licensee of the 63,000+ pharmacies in our network over. Will use first when prescribing you medicine use this example to get started use Availity Part B to enroll a... The account deposit back to the plan ( Updated 02/01/2023 ) Visit thePrior authorization and Step Therapysection for more.! Inc. is an independent licensee of the Anthem websites constitutes your agreement with our Terms of use the.... Carelonrx to provide the greatest value while meeting the needs of our.... 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Authorization phone and fax numbers all prior authorizations will be managed by MedImpact use another,. Request should include why a specific drug is needed and how much is needed how. Treatment of anorexia, weight loss or weight gain this example to get started drug list/formulary material for purposes! Not all prescriptions are available at mail order as a substitute for your care, tiene su... Can get the quantity of medicines you need drugs we cover are carefully selected provide... Pdp ) is accepted coast-to-coast at national pharmacy chains and grocery retailers, Plus thousands of community-based independent pharmacies on. Our Terms of use drugs ) Register on our website to choose to receive plan communications by email online! & t Committee also helps improve customer health through programs like drug utilization review, medication. And generic drugs copays for tier 1 prescription drugs talk to your pharmacist about all medicines you taking. 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