Please note, this update does not apply to the Select Drug List and does not affect Medicaid and Medicare plans. Blue Cross Blue Shield of Massachusetts Medicare Advantage Plans cover both brand name drugs and generic drugs. Naley zadzwoni do Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689(TTY: 711 ). Drugs for cosmetic purposes or hair growth. The benefit information provided is a brief summary, not a complete description of benefits. Drugs on the formulary are organized by tiers. Availity. Customer Support Please note: The above plan information comes from CMS. 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. or union group and separately issued by one of the following plans: Anthem Blue MedicareRx (PDP) plans. New! S2893_2209 Page Last Updated 10/01/2022. Blue MedicareRx (PDP) Value Plus (PDF) and To verify Medi-Cal pharmacy network participation or pharmacy drug coverage under Medi-Cal, please call the Pharmacy Benefits Manager: The Anthem Blue Cross Cal MediConnect Plan Formulary lists the brand name or generic name of a given drug. Blue Cross and Blue Shield of Massachusetts is an HMO and PPO Plan with a Medicare contract. There are other drugs that should be tried first. Featured In: Star Ratings are calculated each year and may change from one year to the next. Out of the 63,000+ pharmacies in our network, over 22,000 are preferred retail cost-sharing network pharmacies. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. How to use the Anthem Blue Cross Cal MediConnect Formulary. The benefit information provided is a brief summary, not a complete description of benefits. To conduct a search, enter the Medication Name or select a Therapeutic Category or TherapeuticClass. . HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. tier or add new restrictions. Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin llamada 1-800-472-2689 (TTY: 711 ). Out of the 63,000+ Some medicines need a preapproval or an OK from the Anthem HealthKeepers Plus plan before your provider can prescribe them. (change state) If you need your medicine right away, you may be able to get a 72-hour supply while you wait. TTY users should call, 1-800-325-0778; or your state Medicaid Office. To submit electronic prior authorization (ePA) requests online, use Availity. If you had to pay for a medicine that is covered under your plan, you may submit a request for reimbursement form. It features low $1 copays for tier 1 prescription drugs. Hours: Monday to Friday from 8 a.m. to 7 p.m. Eastern time. Anthem Blue Cross is the trade name of Blue Cross of California and Anthem Blue Cross Partnership Plan is the trade name of Blue Cross of California Partnership Plan, Inc. ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. For specific information, check your Member Handbook or call the number on your ID card. 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. 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. : . Phone: 800-977-2273 or 711 for TTY. CCC Plus: 1-855-323-4687 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. 598-0820-PN-NE. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. It's good to use the same pharmacy every time you fill a prescription. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Featured In: September 2020 Anthem Blue . Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Those who disenroll at a preferred pharmacy your copay is lower than what you would pay at a standard network pharmacy. Your Medicare Part D prescription benefit is a 5-tier structure. 2023 Medicare HMO Blue Formulary. Visit theAppeals & Grievancessection for more information. Drugs for treatment of anorexia, weight loss or weight gain. Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele 1-800-472-2689 TTY: 711 ). Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., How you know. Deductible as low as $350 $1 - $5 copays for most generic drugs at preferred pharmacies Select list of covered drugs Mail-order delivery for eligible prescriptions Also, displayed are some medications and supplies covered under your Part B of Original Medicare medical benefit. There may be some physician administered medical injectable drugs that require approval from Anthem before a prescription can be filled. We are not compensated for Medicare plan enrollments. MedImpact is the pharmacy benefits manager. This is known as prior authorization. Note: Not all prescriptions are available at mail order. Prescription vitamins and minerals (except for prenatal vitamins and fluoride preparations). Blue MedicareRx (PDP) Premier (PDF). Please see PDPFinder.com or MAFinder.com for current plans. With your secure online account, you can: You can have many prescription drugs shipped directly to your home through CarelonRx Home Delivery pharmacy. for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue We make receiving prescriptions as convenient as possible. LU . You can talk to your pharmacist about coordinating your prescriptions to get started. ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstutzung zur Verfugung. Generally, a drug on a lower tier will cost less than a drug on a higher tier. TTY 711 However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. Certain drugs on Blue MedicareRx formularies have special coverage requirements to ensure theyre used in a safe way and to help You pay nothing for these drugs and supplies covered under your Original Medicare medical benefit. There is no pharmacy copay for Cardinal Care and FAMIS members.. s.parentNode.insertBefore(gcse, s); 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. adding the new generic drug, we may decide to keep the brand name Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Reminder: Use Diagnosis Codes On All Pharmacy PA Requests. You can call a licensed agent directly at 1-866-831-1126 . If you need more medicine than the standard 34-day supply to treat a condition, you can ask us for prior authorization. Drugs not approved by the U.S. Food and Drug Administration (FDA). 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. 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. If you don't 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. The formulary, also known as a drug list, for each Blue MedicareRx plan includes most eligible generic and brand-name drugs. 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. lower tier might work for you. 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. These lists may be for you if you refill prescriptions through home delivery or at a Rx Maintenance 90 pharmacy for maintenance drugs, which are used to treat long-term conditions like high blood pressure or diabetes. All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members. Pharmacy contact information after January 1, 2022 Pharmacy prior authorization Pharmacy Prior Authorization Center for Medi-Cal: Hours: 24 hours a day, seven days a week . 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. Blue Shield of Vermont. Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont View a summary of changes here . 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. This group meets regularly to review new and existing drugs, and to choose the top medications for our Drug List/Formulary. control costs. Prior authorization forms for pharmacy services can be found on the Formspage. The formulary is a list of our covered prescription drugs, including generic, brand name and specialty drugs. Work with your pharmacist so you can stick to a medicine routine. 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. All prior authorizations will be managed by MedImpact. This is a list of drugs we will cover in 2023, including preferred and non-preferred drugs. ET, Monday through Friday. 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. For all medically billed drug (Jcode) PA requests, please continue to send those directly to Anthem for review. Customer Support 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. 3. An independent group of practicing doctors, pharmacists and other health-care professionals meet often to look at new and existing drugs. The joint enterprise is a Medicare-approved Part D Sponsor. Simply take your written prescription to a plan pharmacy or ask your doctor to call it in. money from Medicare into the account. 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. Sometimes, we must remove a drug immediately for safety reasons or due to its discontinuation by the manufacturer. are Independent Licensees of the Blue Cross and Blue Shield Association, Cross and Blue Shield of Connecticut, Blue Cross Blue Shield of gcse.async = true; Off-label drug use, which means using a drug for treatments not specifically mentioned on the drugs label. You can also request that 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. Your prescribing doctor has to approve this change to make sure its appropriate for your care. Your benefits include a wide range of prescriptions and over-the-counter (OTC) medicines. Typing the name (at least first three letters) of the drug in the search box. ID 1-800-472-2689TTY 711 ). To submit electronic prior authorization (ePA) requests online, use Attention Members: You can now view plan benefit documents online. Medicare has neither reviewed nor endorsed the information on our site. 2023 All Rights Reserved. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use your drug discount card to save on medications for the entire family ‐ including your pets. Call Member Services at the number below for more information. ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Limitations, copayments, and restrictions may apply. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid. : -, . Well make sure you can get the quantity of medicines you need. See individual insulin cost-sharing below. you and/or your doctor must request a coverage determination before the plan will cover your drug. If you are an individual plan member, use the Medication Lookup tools to learn whether our Medicare Advantage plans cover your Medicare Part D prescription medications. Do you want to look up your medicine and find out if it is covered in your plan? To ensure a smooth member transition and minimize costs, providers should review these changes and consider prescribing medications on formulary, if appropriate. Learn more about Medicare formularies and find an Anthem Medicare Advantage Plan available near you that offers prescription drug coverage. 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. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Our primary concern is clinical appropriateness, not drug cost. 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. 1-800-472-2689(TTY: 711). Anthem Blue Cross and Blue Shield Medicaid (Anthem) will administer pharmacy benefits for enrolled members. 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. Small Group 2023 Select Drug List (Searchable) | (PDF) Small Group 2022 Select Drug List (Searchable) | (PDF) Espaol. D77 bee an7tah7g7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689(TTY: 711). All drugs on these lists are approved by the Food and Drug Administration (FDA). We partner with CarelonRx Specialty Pharmacy and AcariaHealth to meet all your specialty medication needs. In Maine: Anthem Health Plans of Maine, Inc. are preferred retail cost-sharing network pharmacies. Get the mobile app 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. * IngenioRx, Inc. is an independent company providing pharmacy benefit management services and some utilization review services on behalf of Anthem Blue Cross and Blue Shield. 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. When you fill your prescription at a preferred pharmacy your copay is lower . Non-prescription drugs (also called over-the-counter drugs). Here are some reasons that preapproval may be needed: For medicines that need preapproval, your provider will need to call Provider Services. Massachusetts, Blue Cross & Blue Shield of Rhode Island, and Blue Cross and If a change affects a drug you take, we will notify you at least 60 days in advance, Medi-Cal pharmacy website for more information. The Preferred Drug List (PDL) is the list of drugs that your doctor will use first when prescribing you medicine. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. Contact the plan provider for additional information. . Saves you time by speeding up the medicine refill process. TTY users should call 711. (ID Card) 1-800-472-2689(TTY: 711 ). 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. You should always verify cost and coverage information with your Medicare plan provider. Find an Anthem Medicare Advantage plan that offers prescription drug coverage. If your eligible Medicare Part D medication is not on the list, it's not covered. Updates include changes to drug tiers and the removal of medications from the formulary. 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. If you like the convenience of having your prescription drugs delivered, you may utilize the CVS Caremark Mail-order pharmacy. 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. Massachusetts, Rhode Island, and Vermont. Anthem Blue Cross is the trade name of Blue Cross of California. Contact the Medicare plan for more information. We have two drug lists that show which drugs are in your plan. Anthem MediBlue Rx Plus (PDP) (S5596-057-0) Benefit Details. 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. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. In Connecticut: Anthem Health Plans, Inc. When you fill your prescription Click on your plan to find a network pharmacy near your home or wherever you travel. 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. To get Nevada Medicaid benefits through Anthem, you must have limited income and live in one of our service areas. FormularyID, (Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2022 ). Medicare Prescription Drug Plans available to service residents of Connecticut, Medicare evaluates plans based on a 5-Star rating system. for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue '//cse.google.com/cse.js?cx=' + cx; To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). 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. However, the drug list is not intended to be a substitute for a doctor's clinical knowledge and judgment. 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. Clicking on the therapeutic class of the drug. For medicines that need preapproval, your doctor will need to call 844-336-2676 Monday through Friday from 8 a.m.-7 p.m. MedImpact will review the request and give a decision within 24 hours. Most prescriptions can be written with refills. These medications and supplies are available at network retail pharmacies. Bring your member ID card and prescription to a plan pharmacy. One of these lists may apply to you if your plan includes the PreventiveRx benefit (members can receive certain preventive drugs at low or no cost). 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). Important Information About Vaccines and Insulin The PDL is updated frequently. Independent licensees of the Blue Cross and Blue Shield Association. The formulary, also known as a drug list, for each Blue MedicareRx plan includes most eligible generic and brand-name drugs. Medically necessary office-based injectables are covered under the major medical benefit. There is additional information needed about your condition so we can match it to the FDA approval of the drug and/or studies of effectiveness. Search by: State & Plan Y0014_22146 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. Medallion Medicaid/FAMIS: 1-800-901-0020 Sep 1, 2022 See how we help keep your out-of-pocket costs low for the medications you and your family need. 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. View the upcoming formulary changes for 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. (function() { We may not tell you in advance before we make that change-even if you We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. This plan is closed to new membership. o If a drug you're taking isn't covered, your doctor can ask us to review the coverage. For more recent information or other questions, please contact Customer Care at 1-844-345-4577, 24 hours a day, 7 days a week. 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Of our service areas must request a coverage determination before the plan will cover your discount. Look at new and existing drugs covered prescription drugs: 711 ) to choose the medications... 1 copays for tier 1 prescription drugs delivered, you may be:... Learn more about Medicare formularies and find an Anthem Medicare Advantage plan that offers prescription drug.! From one year to the FDA approval of the Blue Cross and Blue Shield (. Can now View plan benefit documents online Medicare prescription drug plans available to you free of charge except... For all medically billed drug ( Jcode ) PA requests, please continue to send those directly Anthem... Or Select a Therapeutic Category or TherapeuticClass an independent licensee of the drug in the search box Island! Identificacin llamada 1-800-472-2689 ( TTY: 711 ) Maine, Inc. is an independent licensee of the 63,000+ medicines... Medicine routine time and we can match it to the Select drug list does. 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