All drugs on the formulary are covered, but many require preapproval before the prescription can be filled. We may not tell you in advance before we make that change-even if you If you had to pay for a medicine that is covered under your plan, you may submit a request for reimbursement form. Featured In: September 2020 Anthem Blue . Telefone para os Servios aos Membros, atravs do nmero no seu carto ID chamar 1-800-472-2689 (TTY: 711 ). Some medicines need a preapproval or an OK from the Anthem HealthKeepers Plus plan before your provider can prescribe them. SM, TM Registered and Service Marks and Trademarks are property of their respective owners. This list only applies if you have a specialty pharmacy network included in your benefit. Use the Drug Pricing Tool to price the medications you are currently taking and see which Blue MedicareRx plan is best for you. Additionally, Anthem offers a statewide Health Maintenance Organization Plan Option for eligible members and pre-65 Retirees, as well as Medicare Advantage Premium and Standard Plan Options to Medicare-eligible members. ID 1-800-472-2689TTY: 711 . Through Anthem, SHBP offers eligible members, including pre-65 Retirees a choice of three Health Reimbursement Arrangement (HRA) Plan Options: Gold HRA, Silver HRA . You must continue to pay your Medicare Part B premium. (change state) ATANSYON: Si ou pale kreyl ayisyen, svis asistans nan lang disponib pou ou gratis. 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. MedImpact is the pharmacy benefits manager. TTY users should call 711. Call to speak with a licensed insurance agent and find plans in your area. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Click on your plan to find a network pharmacy near your home or wherever you travel. Most prescriptions can be written with refills. 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. An independent group of practicing doctors, pharmacists and other health-care professionals meet often to look at new and existing drugs. the plan cover a drug that is not included in the formulary. 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. PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. The preapproval process helps us make sure that youre taking medications safely and correctly. Enrollment in Blue Cross Blue Shield of Massachusetts depends on contract renewal. money from Medicare into the account. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Compare plans What is a Medicare plan drug formulary? This process is called preapproval or prior authorization. Please direct FFS PA requests and PDL-related questions about hepatitis C drugs to the OptumRx Clinical and Technical Help Desk at 1-855-577-6317. Also, when In some cases, retail drugs and supplies are covered under your Part B of Original Medicare medical benefit (e.g. 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. Cross and Blue Shield of Connecticut, Blue Cross Blue Shield of Limitations, copayments, and restrictions may apply. Compare Anthem Part D Plans MediBlue Rx* Standard Part D Plan This plan is a good choice if you take fewer medications. 'https:' : 'http:') + Benefits, formulary, pharmacy network, premium and/or copayments/co-insurance may change on January 1 of each year. You can also learn more about some of our online tools, like pricing a drug, by clicking on the link to the video. Tier assignments vary by plan. Use your drug discount card to save on medications for the entire family ‐ including your pets. This way, your pharmacist will know about problems that may happen when youre taking more than one prescription. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid. Independent licensees of the Blue Cross and Blue Shield Association. Type at least three letters and we will start finding suggestions for you. An official website of the State of Georgia. 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). We work with CarelonRx to provide these pharmacy benefits. Prior authorization forms for pharmacy services can be found on the Formspage. 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. Medicare Prescription Drug Plans available to service residents of Connecticut, The benefit information provided is a brief summary, not a complete description of benefits. See individual insulin cost-sharing below. To find a pharmacy near you, use our pharmacy locator tool. Medicare Prescription Drug Plans available to service residents of Connecticut, Visit the 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. Enrollment in Blue MedicareRx (PDP) depends on contract renewal. 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. If you dont have Adobe Acrobat Reader, you can download a free copy by clicking HERE. Change State. Providers who do not contract with the plan are not required to see you except in an emergency. 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. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. 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. Before sharing sensitive or personal information, make sure youre on an official state website. The PDL is updated frequently. : . 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. The joint enterprise is a Medicare-approved Part D Sponsor. View a summary of changes here . 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. Your benefits include a wide range of prescription drugs. Check with your employer or contact the Pharmacy Member Services number on your ID card if you need assistance. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. (function() { Anthem is a registered trademark of Anthem Insurance Companies, Inc. Our Medication Synchronization program (Med Sync) makes getting all your medicines easier at no extra cost to you. UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 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). In Ohio: Community Insurance Company. View a summary of changes here . If you need your medicine right away, you may be able to get a 72-hour supply while you wait. Local, state, and federal government websites often end in .gov. 1-800-472-2689( . . .: 711). Get the mobile app We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. or add a special coverage requirement. lancets, test strips). Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at, Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the. tier or add new restrictions. ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. FormularyID, (Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2022 ). Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele 1-800-472-2689 TTY: 711 ). Coverage is available to residents of the service area or members of an employer Drugs that would be covered under Medicare Part A or Part B. We offer an outcomes-based formulary. 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. Plus, you have access to up-to-date coverage information in your drug list, including details about brands and generics, dosage/strength options, and information about prior authorization of your drug. These medications and supplies are available at network retail pharmacies. Blue Shield of Vermont. New! Saves you time by speeding up the medicine refill process. Find an Anthem Medicare Advantage plan that offers prescription drug coverage. 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. For more information, contact the plan. 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. (ID Card) 1-800-472-2689(TTY: 711 ). Note: Not all prescriptions are available at mail order. For more information about tiers, please see yoursummary of benefits. 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. 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. If you misplace your medicine or it is stolen, contact your provider. Independent licensees of the Blue Cross Association. Star Ratings are calculated each year and may change from one year to the next. The joint enterprise is a Medicare-approved Part D Sponsor. Medi-Cal pharmacy website for more information. 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. Your Medicare Part D prescription benefit is a 5-tier structure. The Pharmacy and Therapeutics (P&T) Committee picks drugs considered to be the top choices based on their safety, effectiveness and value for our Drug List/Formulary. Visit thePrior Authorization and Step Therapysection for more information. Call Member Services at the number below for more information. Naley zadzwoni do Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689(TTY: 711 ). are currently taking the brand name drug. drug on our Drug List, but immediately move it to a different cost-sharing Note: Not all prescriptions are available at mail order. You, your prescribing doctor, and a pharmacist work together to replace multiple doses of lower-strength medications with one dose of a higher-strength medication. If you need your medicine right away, you may be able to get a 72-hour supply while you wait. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. Gives your doctor access to key information about you like your medical history, applicable formulary, and potential drug interactions. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Some of the links on this page can only be viewed using Adobe Acrobat Reader. Its good to use the same pharmacy each time you fill a prescription. : , . PDP-Compare: How will each 2021 Part D Plan Change in 2022? Hours: Monday to Friday from 8 a.m. to 7 p.m. Eastern time. Here are some reasons that preapproval may be needed: For medicines that need preapproval, your provider will need to call Provider Services. : -, . 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. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), Cross and Blue Shield of Connecticut, Blue Cross Blue Shield of var cx = 'partner-pub-9185979746634162:fhatcw-ivsf'; Blue MedicareRx Value Plus (PDP) and Blue MedicareRx Premier (PDP) are two To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). (change state) 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. If prior authorization is required, providers must get approval from MedImpact before a prescription can be filled. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. You can talk to your pharmacist about coordinating your prescriptions to get started. 2023 All Rights Reserved. Medallion Medicaid/FAMIS: 1-800-901-0020 To get Nevada Medicaid benefits through Anthem, you must have limited income and live in one of our service areas. You can also request that Blue Shield of Vermont. Well make sure you can get the quantity of medicines you need. Do you want to look up your medicine and find out if it is covered in your plan? Note: For Synagis or other medical injectable drug prior authorizations, please call 1-866-323-4126. area. 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. Getting your prescriptions filled is easy. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. Use the formulary to search by drug name or disease category: For Medi-Cal drug coverage, please use the Medi-Cal Contract Drug List. lower cost sharing tier and with the same or fewer restrictions. The PDL includes all medications covered by Medicaid, including some over-the-counter drugs. ET, seven days a week. In Indiana: Anthem Insurance Companies, Inc. However, they do not qualify for exception requests, extra help on drug costs,transition fills, or accumulate toward your total out of pocket costs to bring you through the coverage gap faster like drugs covered under your Medicare prescription drug benefit. Availity. gcse.type = 'text/javascript'; Clicking on the therapeutic class of the drug. All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members. This is a list of drugs we will cover in 2023, including preferred and non-preferred drugs. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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. All prior authorizations will be managed by MedImpact. MedImpact, in conjunction with the Commonwealth of Kentucky, manages a list of drugs providers can choose from called a Preferred Drug List (PDL). The Anthem HealthKeepers Plus plan will review the request and give a decision within 24 hours. control costs. They will work with the pharmacy and the Anthem HealthKeepers Plus plan to review your case and replace your medicines as needed. 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. We have two drug lists that show which drugs are in your plan. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. The latest developments and submission guidelines from around the world are considered when developing and maintaining the drug list/formulary. Use this form to set up home delivery for your prescriptions. Y0014_22146 Page Last Updated: 05/13/2022 Dose optimization, or dose consolidation, helps you stick with your medicine routine. 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. This is known as prior authorization. If you use another pharmacy, you should tell the pharmacist about all medicines you are taking. Formularies 2023 FEP Blue Focus Formulary View List 2023 Basic Option Formulary View List 2023 Standard Option Formulary View List Drug tiers If a change affects a drug you take, we will notify you at least 60 days in advance, 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 Generic Premium Drug List is no longer actively marketed and only applies to members who have not been transitioned to an alternative drug list. Use of the Anthem Web sites constitutes your agreement with our Terms of Use. Attention Members: You can now view plan benefit documents online. And deductibles may vary based on the formulary to search by drug name or category..., copayments, and deductibles may vary based on the formulary to search drug! 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