'https:' : 'http:') + The Preferred Drug List (PDL) is the list of drugs that your doctor will use first when prescribing you medicine. 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. ET, Monday through Friday. New! 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. Compare plans What is a Medicare plan drug formulary? This tool will help you learn about any limitations or restrictions for any rug. Medicare Prescription Drug Plans available to service residents of Connecticut, Appelez le Service adhrents au numro indiqu sur votre carte dassur appel1-800-472-2689 (TTY : 711 ). Your prescribing doctor has to approve this change to make sure its appropriate for your care. You can also learn more about some of our online tools, like pricing a drug, by clicking on the link to the video. lower cost sharing tier and with the same or fewer restrictions. o You can search for generic drugs at anthem.com. Medicare has neither reviewed nor endorsed the information on our site. ET, seven days a week. Customer Support 1-800-472-2689( . . .: 711). Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., S2893_2209 Page Last Updated 10/15/2022. Please note, this update does not apply to the Select Drug List and does not impact Medicaid and Medicare plans. The plan deposits ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. For more information about tiers, please see yoursummary of benefits. All prior authorizations will be managed by MedImpact. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. 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. We offer an outcomes-based formulary. That way, your pharmacists will know about problems that could occur when you're . Medicare evaluates plans based on a 5-Star rating system. You can search or print your drug list from the options below. and SM Service Marks are the property of their respective owners. To request a printed copy of our pharmacy directory call us, 24 hours a day, 7 days a week. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), Independent licensees of the Blue Cross and Blue Shield Association. In Indiana: Anthem Insurance Companies, Inc. For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. 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. 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. Use the Drug Pricing Tool to price the medications you are currently taking and see which Blue MedicareRx plan is best for you. Dose optimization, or dose consolidation, helps you stick with your medicine routine. There is a generic or pharmacy alternative drug available. Naley zadzwoni do Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689(TTY: 711 ). The request should include why a specific drug is needed and how much is needed. View the upcoming formulary changes for PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. It lists all the drugs found on the PDL, plus others. Pharmacy services billed as a medical (professional) or institutional claim (or their electronic equivalents) are not in scope. View a summary of changes here . All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). If you dont see your medicine listed on the drug lists, you may ask for an exception at submitmyexceptionreq@anthem.com or by calling Pharmacy Member Services at 833-207-3120.Youll be asked to supply a reason why it should be covered, such as an allergic reaction to a drug, etc. The formulary, also known as a drug list, for each Blue MedicareRx plan includes most eligible generic and brand-name drugs. 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. Your Medicare Part D prescription benefit is a 5-tier structure. Learn more about Medicare formularies and find an Anthem Medicare Advantage Plan available near you that offers prescription drug coverage. Some of the links on this page can only be viewed using Adobe Acrobat Reader. : , . Phone: 800-977-2273 or 711 for TTY. Call 1-800-901-0020 (TTY 711). Some medicines need a preapproval or an OK from the Anthem HealthKeepers Plus plan before your provider can prescribe them. For specific information, check your Member Handbook or call the number on your ID card. : -, . An official website of the State of Georgia. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 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. 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. Typing the name (at least first three letters) of the drug in the search box. Products & Programs / Pharmacy. These kinds of medicines arent paid for by your plan: Click here to see the list of medications available for 90-day supply. 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. If you like the convenience of having your prescription drugs delivered, you may utilize the CVS Caremark Mail-order pharmacy. The P&T Committee also helps improve customer health through programs like drug utilization review, promoting medication safety and encouraging compliance. Coverage is available to residents of the service area or members of an employer In certain situations, you can. In Kentucky: Anthem Health Plans of Kentucky, Inc. To submit electronic prior authorization (ePA) requests online, use Availity. Blue MedicareRx (PDP) is accepted coast-to-coast at national pharmacy chains and grocery retailers, plus thousands of community-based independent pharmacies. If you dont have Adobe Acrobat Reader, you can download a free copy by clicking HERE. You can talk to your pharmacist about coordinating your prescriptions to get started. If your eligible Medicare Part D medication is not on the list, it's not covered. If you need your medicine right away, you may be able to get a 72-hour supply while you wait. Generic drugs have the same active ingredient formula as a brand name drug. If you need your medicine right away, you may be able to get a 72-hour supply while you wait. The joint enterprise is a Medicare-approved Part D Sponsor. In Ohio: Community Insurance Company. Sep 1, 2022 Blue MedicareRx formularies may change during a calendar year if we remove a drug, change a drugs tier, Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. In Connecticut: Anthem Health Plans, Inc. Most prescriptions can be written with refills. This process is called preapproval or prior authorization. This plan is closed to new membership. or add a special coverage requirement. Also, displayed are some medications and supplies covered under your Part B of Original Medicare medical benefit. 24 hours a day/7 days a week or consult, When enrolling in a Medicare Advantage plan, you must continue to pay your. Do you want to look up your medicine and find out if it is covered in your plan? Note: Not all prescriptions are available at mail order. Enrollment in Blue MedicareRx (PDP) depends on contract renewal. We partner with CarelonRx Specialty Pharmacy and AcariaHealth to meet all your specialty medication needs. SM, TM Registered and Service Marks and Trademarks are property of their respective owners. Featured In: Type at least three letters and well start finding suggestions for you. are the legal entities which have contracted as a joint enterprise with the Centers drug on our Drug List, but immediately move it to a different cost-sharing Blue Cross Blue Shield of Massachusetts Medicare Advantage Plans cover both brand name drugs and generic drugs. '//cse.google.com/cse.js?cx=' + cx; Blue MedicareRx Value Plus (PDP) and Blue MedicareRx Premier (PDP) are two 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. : , , . We make receiving prescriptions as convenient as possible. Cross and Blue Shield of Connecticut, Blue Cross Blue Shield of Registered Marks of the Blue Cross and Blue Shield Association. Anthem Blue Cross and Blue Shield Medicaid (Anthem) will administer pharmacy benefits for enrolled members. Prior authorization phone and fax numbers All prior authorizations will be managed by MedImpact. The Anthem HealthKeepers Plus plan also covers many over-the-counter (OTC) medicines with a prescription from your doctor. To conduct a search, enter the Medication Name or select a Therapeutic Category or TherapeuticClass. Blue MedicareRx (PDP) Premier (PDF). An independent group of practicing doctors, pharmacists and other health-care professionals meet often to look at new and existing drugs. Drugs that would be covered under Medicare Part A or Part B. or union group and separately issued by one of the following plans: Anthem Blue The benefit information provided is a brief summary, not a complete description of benefits. ATANSYON: Si ou pale kreyl ayisyen, svis asistans nan lang disponib pou ou gratis. Use the formulary to search by drug name or disease category: For Medi-Cal drug coverage, please use the Medi-Cal Contract Drug List. See individual insulin cost-sharing below. Blue MedicareRx (PDP) is accepted coast-to-coast at national pharmacy chains and grocery retailers, plus thousands of community-based independent pharmacies. Updates include changes to drug tiers and the removal of medications from the formulary. 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. You can call a licensed agent directly at 1-866-831-1126 . The changes apply for only new prescriptions; members with existing prescriptions for these medications will not be impacted. MedicareRx (PDP) plans. You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. See how we help keep your out-of-pocket costs low for the medications you and your family need. 2022 Medicare Part D Plan Formulary Information. Please note, this update does not apply to the Select Drug List and does not affect Medicaid and Medicare plans. 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. 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. control costs. This ensures that our members use these drugs in a safe way. var gcse = document.createElement('script'); 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. If prior authorization is required, providers must get approval from MedImpact before a prescription can be filled. Out of the 63,000+ pharmacies in our network, over 22,000 are preferred retail cost-sharing network pharmacies. 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. Massachusetts, Rhode Island, and Vermont. Contact the plan provider for additional information. Registered Marks of Blue Cross and Blue Shield of Massachusetts, Inc., and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. Registered Marks, TM Trademarks. Prior authorization forms for pharmacy services can be found on the Formspage. Drugs not approved by the U.S. Food and Drug Administration (FDA). For more recent information or other questions, please contact Customer Care at 1-844-345-4577, 24 hours a day, 7 days a week. This list of specialty medications is not covered under the medical benefit for certain groups. 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). IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. or union group and separately issued by one of the following plans: Anthem Blue 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. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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. 2. Non-prescription drugs (also called over-the-counter drugs). (function() { Tier assignments vary by plan. Here are some reasons that preapproval may be needed: For medicines that need preapproval, your provider will need to call Provider Services. TTY users should call, 1-800-325-0778; or your state Medicaid Office. To request a drug be added to the Preferred Drug List (PDL), please contact Anthem via the. . 2022 Part D Formulary (List of Covered Drugs) Register on our website to choose to receive plan communications by email or online. the plan cover a drug that is not included in the formulary. ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstutzung zur Verfugung. Attention Members: You can now view plan benefit documents online. For MRMIP and MMP: Prescriptions can be filled at more than 5,000 retail pharmacies in California and a listing of these pharmacies (pharmacy network) can be found in our provider directories. ID 1-800-472-2689TTY: 711 . This list of specialty medications is not covered under the pharmacy benefit for certain groups. Limitations, copayments, and restrictions may apply. Saves you time by speeding up the medicine refill process. Its easy when you use our search tool. All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members. Members may enroll in a Medicare Advantage plan only during specific times of the year. Well make sure you can get the quantity of medicines you need. They choose drugs for these lists based on a number of factors including how well they work, value to patients and safety. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag1-800-472-2689(TTY: 711 ). during the calendar year will owe a portion of the account deposit back to the plan. We work with CarelonRx to provide these pharmacy benefits. We may not tell you in advance before we make that change-even if you The PDL is updated frequently. Change State. Sometimes, we must remove a drug immediately for safety reasons or due to its discontinuation by the manufacturer. However, the drug list is not intended to be a substitute for a doctor's clinical knowledge and judgment. 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. Star Ratings are calculated each year and may change from one year to the next. To submit electronic prior authorization (ePA) requests online, use Blue Cross and Blue Shield of Massachusetts is an HMO and PPO Plan with a Medicare contract. Out of the 63,000+ They will work with the pharmacy and the Anthem HealthKeepers Plus plan to review your case and replace your medicines as needed. 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. Blue Shield of Vermont. This list only applies if you have a specialty pharmacy network included in your benefit. October 1 through March 31, 8:00 a.m. to 8:00 p.m. Independent licensees of the Blue Cross Association. Those who disenroll In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. pharmacies in our network, over 22,000 Certain drugs on Blue MedicareRx formularies have special coverage requirements to ensure theyre used in a safe way and to help TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult. PlanID Simply take your written prescription to a plan pharmacy or ask your doctor to call it in. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan. 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. For all medically billed drug (Jcode) PA requests, please continue to send those directly to Anthem for review. Massachusetts, Rhode Island, and Vermont. Get the mobile app Medicare Advantage plan, you can download a free copy by clicking here the Medi-Cal drug! 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Prescription benefit is a 5-tier structure to the plan drugs at anthem.com only prescriptions... Applies if you like the convenience of having your prescription drugs delivered, may. Submit electronic prior authorization phone and fax numbers all prior authorizations will be by! Enterprise is a Medicare MSA plan, you may be able to get a supply... Depends on contract renewal conduct a search, enter the medication name Select... For 90-day supply the plan cover a drug be added to the next plan by! Medi-Cal drug coverage ) of the 63,000+ pharmacies in our network, over 22,000 are preferred retail cost-sharing pharmacies. Prior authorizations will be managed by MedImpact out-of-pocket costs low for the medications and! Suggestions for you if your eligible Medicare Part D formulary ( list of specialty medications is not intended be... Medicare plans services billed as a medical ( professional ) or institutional claim ( or their electronic equivalents are! 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Enrolled members by clicking here specific information, check your Member Handbook or call the number on your card! Its discontinuation by the U.S. Food and drug Administration ( FDA ) pharmacy directory call us, 24 hours day/7...