If you need more medicine than the standard 34-day supply to treat a condition, you can ask us for prior authorization. Small Group 2023 Select Drug List (Searchable) | (PDF) Small Group 2022 Select Drug List (Searchable) | (PDF) Espaol. Enrollment in Blue Cross Blue Shield of Massachusetts depends on contract renewal. (ID Card) 1-800-472-2689(TTY: 711 ). ET, seven days a week. during the calendar year will owe a portion of the account deposit back to the plan. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. Most prescriptions can be written with refills. 3. 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. The final decision for a patient's drug therapy always rests with the physician. There are certain types of drugs that Blue MedicareRx cannot include in the formulary due to federal law, including: In addition, a Medicare Part D plan cannot cover: Blue MedicareRx (PDP) is a Prescription Drug Plan with a Medicare contract. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag1-800-472-2689(TTY: 711 ). SM, TM Registered and Service Marks and Trademarks are property of their respective owners. The joint enterprise is a Medicare-approved Part D Sponsor. Local, state, and federal government websites often end in .gov. The P&T Committee also helps improve customer health through programs like drug utilization review, promoting medication safety and encouraging compliance. If you use another pharmacy, you should tell the pharmacist about all medicines you are taking. Typing the name (at least first three letters) of the drug in the search box. It features low $1 copays for tier 1 prescription drugs. s.parentNode.insertBefore(gcse, s); TTY 711 The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins. Your benefits include a wide range of prescriptions and over-the-counter (OTC) medicines. Drugs to relieve a cough or cold symptoms. If a change affects a drug you take, we will notify you at least 60 days in advance, for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue Blue MedicareRx Value Plus (PDP) and Blue MedicareRx Premier (PDP) are two var gcse = document.createElement('script'); MedicareRx (PDP) plans. lancets, test strips). These drugs have been chosen for their quality and effectiveness. Appelez le Service adhrents au numro indiqu sur votre carte dassur appel1-800-472-2689 (TTY : 711 ). To request a printed copy of our pharmacy directory call us, 24 hours a day, 7 days a week. How to use the Anthem Blue Cross Cal MediConnect Formulary. To ensure a smooth member transition and minimize costs, providers should review these changes and consider prescribing medications on formulary, if appropriate. ZIP & Plan Your doctor can get the process started by calling the Pharmacy Member Services number on S2893_2209 Page Last Updated 10/01/2022. All drugs on the formulary are covered, but many require preapproval before the prescription can be filled. 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. Availity. You may ask us to cover a Medicare Part D medication not listed on our formulary by requesting a formulary exception to waive coverage restrictions or limits on your medication. CCC Plus: 1-855-323-4687 Some of the links on this page can only be viewed using Adobe Acrobat Reader. The joint enterprise is a Medicare-approved Part D Sponsor. Enrollment in Blue MedicareRx (PDP) depends on contract renewal. 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). We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. Find an Anthem Medicare Advantage plan that offers prescription drug coverage. Also, displayed are some medications and supplies covered under your Part B of Original Medicare medical benefit. Get the mobile app We look forward to working with you to provide quality services to our members. 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. There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. These medications and supplies are available at network retail pharmacies. Limitations, copayments, and restrictions may apply. Limitations, copayments, and restrictions may apply. Anthem MediBlue Rx Plus (PDP) (S5596-057-0) Benefit Details. Getting your prescriptions filled is easy. 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. Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele 1-800-472-2689 TTY: 711 ). In certain situations, you can. (change state) Drugs requiring the assistance of a medical professional (office-based injectables) are not covered under the pharmacy benefit. 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. In Kentucky: Anthem Health Plans of Kentucky, Inc. However, the drug list is not intended to be a substitute for a doctor's clinical knowledge and judgment. Medicare Prescription Drug Plans available to service residents of Connecticut, View a summary of changes here. Star Ratings are calculated each year and may change from one year to the next. If you have a complex or chronic health condition that requires special medicine, you can get the medicine you need. 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. Phone: 800-977-2273 or 711 for TTY. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. 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. Cross and Blue Shield of Connecticut, Blue Cross Blue Shield of View a summary of changes here . 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. Prescription vitamins and minerals (except for prenatal vitamins and fluoride preparations). The drug is prescribed at a higher dosage than recommended. Coverage is available to residents of the service area or members of an employer ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement. Visit theAppeals & Grievancessection for more information. 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 Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont are the legal entities that have contracted as a joint enterprise with the Centers for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue MedicareRx (PDP) plans. View the upcoming formulary changes for Drugs that would be covered under Medicare Part A or Part B. Generic drugs have the same active ingredient formula as a brand name drug. The preapproval process helps us make sure that youre taking medications safely and correctly. Benefits, formulary, pharmacy network, premium and/or copayments/co-insurance may change on January 1 of each year. or add a special coverage requirement. Check with your employer or contact the Pharmacy Member Services number on your ID card if you need assistance. For more information contact the plan. Sep 1, 2020 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. Blue Shield of Vermont. Medicare MSA Plans do not cover prescription drugs. ET, Monday through Friday. Contact Anthem Blue Cross and Blue Shield. UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. (function() { 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. PlanID Your benefits include a wide range of prescription drugs. An official website of the State of Georgia. We have two drug lists that show which drugs are in your plan. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Products & Programs / Pharmacy. For more information, contact the plan. Visit the Hours: Monday to Friday from 8 a.m. to 7 p.m. Eastern time. Products & Programs / Pharmacy. 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. Please note, this update does not apply to the Select Drug List and does not affect Medicaid and Medicare plans. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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. Be sure to show the pharmacy your Anthem member ID card. 634-0920-PN-CONV. The formulary, also known as a drug list, for each Blue MedicareRx plan includes most eligible generic and brand-name drugs. Drugs for cosmetic purposes or hair growth. '//cse.google.com/cse.js?cx=' + cx; This group meets regularly to review new and existing drugs, and to choose the top medications for our Drug List/Formulary. . HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., 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). When you fill your prescription at a preferred pharmacy your copay is lower . Medallion Medicaid/FAMIS: 1-800-901-0020 We work with CarelonRx to provide these pharmacy benefits. Drugs on the formulary are organized by tiers. An independent group of practicing doctors, pharmacists and other health-care professionals meet often to look at new and existing drugs. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. 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). The changes apply for only new prescriptions; members with existing prescriptions for these medications will not be impacted. The Anthem HealthKeepers Plus plan will review the request and give a decision within 24 hours. Call 1-800-472-2689 (TTY: 711). 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. Here are some reasons that preapproval may be needed: For medicines that need preapproval, your provider will need to call Provider Services. adding the new generic drug, we may decide to keep the brand name We are an independent education, research, and technology company. It lists all the drugs found on the PDL, plus others. The plan deposits 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. If you need your medicine right away, you may be able to get a 72-hour supply while you wait. 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. Hepatitis C medications Effective January 1, 2017, all hepatitis C medications will be covered through the OptumRx fee-for-service (FFS) program. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid. Use of the Anthem Web sites constitutes your agreement with our Terms of Use. Massachusetts, Rhode Island, and Vermont. This way, your pharmacist will know about problems that may happen when youre taking more than one prescription. Generally, a drug on a lower tier will cost less than a drug on a higher tier. Drugs for treatment of sexual or erectile dysfunction (ED). 2022 Formulary for Open Enrollment This is a list of drugs we will cover in 2023, including preferred and non-preferred drugs. Type at least three letters and well start finding suggestions for you. If you have the Traditional Open formulary/drug list, this PreventiveRx drug list may apply to you: For PreventiveRx Plus and if you have the Select formulary/drug list, this PreventiveRx Plus drug list may apply to you: For Legacy PreventiveRx Plus 2016 and if you have the Select formulary/drug list, this PreventiveRx Plus drug list may apply to you: This list includes the specialty drugs that must be filled through a participating specialty pharmacy in order for coverage to be provided. Learn more about Medicare formularies and find an Anthem Medicare Advantage Plan available near you that offers prescription drug coverage. That means we use a balanced approach to drug list/formulary management, based on a combination of research, clinical guidelines and member experience. Work with your pharmacist so you can stick to a medicine routine. To request a printed copy of our pharmacy directory call us, 24 hours a day, 7 days a week. Before sharing sensitive or personal information, make sure youre on an official state website. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689(TTY: 711 ). When you fill your prescription Customer Support You can also learn more about some of our online tools, like pricing a drug, by clicking on the link to the video. Out of the 63,000+ pharmacies in our network, over 22,000 are preferred retail cost-sharing network pharmacies. The Preferred Drug List (PDL) is the list of drugs that your doctor will use first when prescribing you medicine. You can fill your prescriptions at more than 5,000 retail pharmacies in your plan across Virginia. the plan cover a drug that is not included in the formulary. For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. In some cases, retail drugs and supplies are covered under your Part B of Original Medicare medical benefit (e.g. The formulary is a list of all brand-name and generic drugs available in your plan. We partner with CarelonRx Specialty Pharmacy and AcariaHealth to meet all your specialty medication needs. Formularies 2023 FEP Blue Focus Formulary View List 2023 Basic Option Formulary View List 2023 Standard Option Formulary View List Drug tiers ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Use this form to set up home delivery for your prescriptions. Type at least three letters and we will start finding suggestions for you. Your prescribing doctor has to approve this change to make sure its appropriate for your care. Certain drugs on Blue MedicareRx formularies have special coverage requirements to ensure theyre used in a safe way and to help 24 hours a day/7 days a week or consult, When enrolling in a Medicare Advantage plan, you must continue to pay your. Blue Shield of Vermont. pharmacies in our network, over 22,000 Using the A to Z list to search by the first letter of your drug. Drugs on the formulary are organized by tiers. 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. We make receiving prescriptions as convenient as possible. gcse.type = 'text/javascript'; If a sudden removal occurs, we will notify our affected members as soon as possible. Telefone para os Servios aos Membros, atravs do nmero no seu carto ID chamar 1-800-472-2689 (TTY: 711 ). Bring your member ID card and prescription to a plan pharmacy. To submit electronic prior authorization (ePA) requests online, use or union group and separately issued by one of the following plans: Anthem Blue 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. for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Reminder: Use Diagnosis Codes On All Pharmacy PA Requests. Medicare has neither reviewed nor endorsed the information on our site. Medi-Cal pharmacy website for more information. These kinds of medicines arent paid for by your plan: Click here to see the list of medications available for 90-day supply. March 2023 Anthem Blue Cross Provider News - California, Action required: 2023 Consumer Grievance and Appeals attestation Requirement, Group number change for Screen Actors Guild-American Federation of Television and Radio Artists Health Plan, February 2023 Anthem Blue Cross Provider News - California, January 2023 Anthem Blue Cross Provider News - California, September 2020 Anthem Blue Cross Provider News - California. If you had to pay for a medicine that is covered under your plan, you may submit a request for reimbursement form. and SM Service Marks are the property of their respective owners. 2021 Blue Cross and Blue Shield of Massachusetts, Inc., or Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. April 1 through September 30, 8:00 a.m. to 8:00 p.m. Through Anthem, SHBPoffers eligible members, including pre-65 Retirees a choice of three Health Reimbursement Arrangement (HRA) Plan Options: Gold HRA, Silver HRA and Bronze HRA. 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