Certain drugs on Blue MedicareRx formularies have special coverage requirements to ensure theyre used in a safe way and to help To find a pharmacy near you, use our pharmacy locator tool. Blue Cross and Blue Shield of Massachusetts is an HMO and PPO Plan with a Medicare contract. Contact the Pharmacy Member Services number on your ID card if you need assistance. Drugs that would be covered under Medicare Part A or Part B. 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. You can also learn more about some of our online tools, like pricing a drug, by clicking on the link to the video. In Ohio: Community Insurance Company. 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 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). 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. Customer Support 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. The Anthem HealthKeepers Plus plan also covers many over-the-counter (OTC) medicines with a prescription from your doctor. You may also submit your request online through Cover My Meds, Surescripts, or CenterX ePA portals. View a summary of changes here. Blue MedicareRx (PDP) Premier (PDF). If you dont have Adobe Acrobat Reader, you can download a free copy by clicking HERE. o You can search for generic drugs at anthem.com. 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. Drugs not approved by the U.S. Food and Drug Administration (FDA). 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. . HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. are currently taking the brand name drug. Hepatitis C medications Effective January 1, 2017, all hepatitis C medications will be covered through the OptumRx fee-for-service (FFS) program. Find an Anthem Medicare Advantage plan that offers prescription drug coverage. The joint enterprise is a Medicare-approved Part D Sponsor. Also, displayed are some medications and supplies covered under your Part B of Original Medicare medical benefit. Select your search style and criteria below or use this example to get started We look forward to working with you to provide quality services to our members. 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. Limitations, copayments, and restrictions may apply. 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. Hours: Monday to Friday from 8 a.m. to 7 p.m. Eastern time. 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. View the upcoming formulary changes for For all medically billed drug (Jcode) PA requests, please continue to send those directly to Anthem for review. The formulary, also known as a drug list, for each Blue MedicareRx plan includes most eligible generic and brand-name drugs. LU . 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. A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. MedicareRx (PDP) plans. 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. If you use another pharmacy, you should tell the pharmacist about all medicines you are taking. or add a special coverage requirement. The P&T Committee also helps improve customer health through programs like drug utilization review, promoting medication safety and encouraging compliance. Drugs for treatment of anorexia, weight loss or weight gain. We are not compensated for Medicare plan enrollments. If you need your medicine right away, you may be able to get a 72-hour supply while you wait. This ensures that our members use these drugs in a safe way. We work with CarelonRx to provide these pharmacy benefits. ATENO: Se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas. 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). 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 amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins. These requirements include: If you believe your use of a drug meets all special requirements, or that you should be exempt from a requirement, We may immediately remove a brand name drug on our Drug List if we Non-prescription drugs (also called over-the-counter drugs). The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. This plan covers select insulin pay $35 copay. Generic drugs have the same active ingredient formula as a brand name drug. Drugs on the formulary are organized by tiers. 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. and SM Service Marks are the property of their respective owners. : . OTC drugs aren't shown on the list. Blue MedicareRx (PDP) Value Plus (PDF) and Massachusetts, Rhode Island, and Vermont. Phone: 800-977-2273 or 711 for TTY. To submit electronic prior authorization (ePA) requests online, use Availity. You can log in to your account and manage your prescriptions filled through home-delivery pharmacy. are preferred retail cost-sharing network pharmacies. during the calendar year will owe a portion of the account deposit back to the plan. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., New! var gcse = document.createElement('script'); lancets, test strips). Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid. For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). Anthem Blue Cross is the trade name of Blue Cross of California. This process is called preapproval or prior authorization. This is a list of drugs we will cover in 2023, including preferred and non-preferred drugs. Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you, even if you havent paid your deductible (if applicable.) If you like the convenience of having your prescription drugs delivered, you may utilize the CVS Caremark Mail-order pharmacy. To request a drug be added to the Preferred Drug List (PDL), please contact Anthem via the. Cross and Blue Shield of Connecticut, Blue Cross Blue Shield of 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. This plan is closed to new membership. 1-800-472-2689( . . .: 711). Products & Programs / Pharmacy. Page Last Updated: 05/13/2022 The benefit information provided is a brief summary, not a complete description of benefits. var cx = 'partner-pub-9185979746634162:fhatcw-ivsf'; Massachusetts, Blue Cross & Blue Shield of Rhode Island, and Blue Cross and 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. Blue MedicareRx (PDP) is a Prescription Drug Plan with a Medicare contract. 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. If youre interested in saving money on your prescriptions, discuss with your doctor whether switching to a similar drug on a ET, seven days a week. 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. Have more questions about Med Sync? All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members. Simply take your written prescription to a plan pharmacy or ask your doctor to call it in. Get the mobile app Anthem is a registered trademark. You should always verify cost and coverage information with your Medicare plan provider. Note: For Synagis or other medical injectable drug prior authorizations, please call 1-866-323-4126. For more information, contact the plan. The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change. 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. 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. Note: Not all prescriptions are available at mail order. 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. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Our primary concern is clinical appropriateness, not drug cost. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. You can also request that 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. 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. 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. FormularyID, (Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2022 ). An official website of the State of Georgia. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. Some medicines need a preapproval or an OK from the Anthem HealthKeepers Plus plan before your provider can prescribe them. MedImpact, in conjunction with the Commonwealth of Kentucky, manages a list of drugs providers can choose from called a Preferred Drug List (PDL). Prior authorization forms for pharmacy services can be found on the Formspage. Click on your plan to find a network pharmacy near your home or wherever you travel. ATANSYON: Si ou pale kreyl ayisyen, svis asistans nan lang disponib pou ou gratis. 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. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Reminder: Use Diagnosis Codes On All Pharmacy PA Requests. We rely on objective evaluations from independent physicians. Dose optimization, or dose consolidation, helps you stick with your medicine routine. Enrollment in Blue Cross Blue Shield of Massachusetts depends on contract renewal. gcse.type = 'text/javascript'; Attention Members: You can now view plan benefit documents online. 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