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. The request should include why a specific drug is needed and how much is needed. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. If youre interested in saving money on your prescriptions, discuss with your doctor whether switching to a similar drug on a 1-800-472-2689(TTY: 711) . 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. ID 1-800-472-2689TTY: 711 . The drug has a high side effect potential. Medicare MSA Plans do not cover prescription drugs. 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. TTY users should call 711. 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. All drugs on the formulary are covered, but many require preapproval before the prescription can be filled. 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. 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. PDP-Compare: How will each 2021 Part D Plan Change in 2022? 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. We have two drug lists that show which drugs are in your plan. 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. Formularies 2023 FEP Blue Focus Formulary View List 2023 Basic Option Formulary View List 2023 Standard Option Formulary View List Drug tiers Do not sell or share my personal information. To help 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. PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Check with your employer or contact the Pharmacy Member Services number on your ID card if you need assistance. 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). 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. Note: Not all prescriptions are available at mail order. : , . All other drugs are limited to a 34-day supply. Limitations, copayments, and restrictions may apply. Generally, a drug on a lower tier will cost less than a drug on a higher tier. var gcse = document.createElement('script'); : , , . 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. Your Medicare Part D prescription benefit is a 5-tier structure. Contact the Medicare plan for more information. Drugs to relieve a cough or cold symptoms. TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. Note: Not all prescriptions are available at mail order. If you have a complex or chronic health condition that requires special medicine, you can get the medicine you need. or add a special coverage requirement. The Blue Cross name and symbol are registered marks of the Blue Cross Association. TTY 711 English Spanish Don't see it listed? Its good to use the same pharmacy each time you fill a prescription. When you fill your prescription at a preferred pharmacy your copay is lower . Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) 2019 List of Covered Drugs (Formulary), Medi-Cal Managed Care and Major Risk Medical Insurance Program Provider Manual, Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Provider Manual, MMP: Medical Injectables Prior Authorization Form, Drug List Addition/Clinical Criteria Change Request Form. The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change. 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. Off-label drug use, which means using a drug for treatments not specifically mentioned on the drugs label. The final decision for a patient's drug therapy always rests with the physician. 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. This way, your pharmacist will know about problems that may happen when youre taking more than one prescription. ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstutzung zur Verfugung. Out of the 63,000+ LU . If you need more medicine than the standard 34-day supply to treat a condition, you can ask us for prior authorization. You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. MedicareRx (PDP) plans. All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members. Use the Drug Pricing Tool to price the medications you are currently taking and see which Blue MedicareRx plan is best for you. How to use the Anthem Blue Cross Cal MediConnect Formulary. 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.) Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen1-800-472-2689(TTY: 711 ). To request a drug be added to the Preferred Drug List (PDL), please contact Anthem via the. 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. Blue Cross Blue Shield of Massachusetts Medicare Advantage Plans cover both brand name drugs and generic drugs. Generic drugs have the same active ingredient formula as a brand name drug. To get Nevada Medicaid benefits through Anthem, you must have limited income and live in one of our service areas. 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. 1-800-472-2689(TTY: 711). Make sure you have your medicines when you need them. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. All drugs on these lists are approved by the Food and Drug Administration (FDA). Blue MedicareRx formularies may change during a calendar year if we remove a drug, change a drugs tier, pharmacies in our network, over 22,000 Getting your prescriptions filled is easy. 24 hours a day/7 days a week or consult, When enrolling in a Medicare Advantage plan, you must continue to pay your. The Anthem HealthKeepers Plus plan also covers many over-the-counter (OTC) medicines with a prescription from your doctor. 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. 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 For specific information, check your Member Handbook or call the number on your ID card. Blue Cross and Blue Shield of Massachusetts is an HMO and PPO Plan with a Medicare contract. It lists all the drugs found on the PDL, plus others. Featured In: See individual insulin cost-sharing below. Contact the plan provider for additional information. ET, Monday through Friday. Enrollment in Blue Cross Blue Shield of Massachusetts depends on contract renewal. Change State. Medicare evaluates plans based on a 5-Star rating system. To request a printed copy of our pharmacy directory call us, 24 hours a day, 7 days a week. Products & Programs / Pharmacy. ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Registered Marks of the Blue Cross and Blue Shield Association. We offer an outcomes-based formulary. lower cost sharing tier and with the same or fewer restrictions. Simply take your written prescription to a plan pharmacy or ask your doctor to call it in. Y0014_22146 Get started with Med Sync today. 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. Massachusetts, Rhode Island, and Vermont. Its easy when you use our search tool. Availity. It features low $1 copays for tier 1 prescription drugs. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. 2. 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. Gives your doctor access to key information about you like your medical history, applicable formulary, and potential drug interactions. : Nu quy v n.i Ting Vit, c.c dch v h tr ng.n ng c cung cp cho quy v min ph.. Gi cho Dch v Hi vi.n theo s tr.n th ID ca quy v Cuc gi 1-800-472-2689(TTY: 711 ). Some of the links on this page can only be viewed using Adobe Acrobat Reader. The preapproval process helps us make sure that youre taking medications safely and correctly. : , . ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Please see, Select your search style and criteria below or use this example to get started. gcse.async = true; Blue MedicareRx (PDP) Premier (PDF). 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. are preferred retail cost-sharing network pharmacies. Member Service 1-800-472-2689(TTY: 711). View a summary of changes here . Important Information About Vaccines and Insulin Last Updated: 03/01/2023. Drugs requiring the assistance of a medical professional (office-based injectables) are not covered under the pharmacy benefit. Anthem Blue Cross and Blue Shield Medicaid (Anthem) will administer pharmacy benefits for enrolled members. Sep 1, 2022 Products & Programs / Pharmacy 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. Medicare Prescription Drug Plans available to service residents of Connecticut, To submit electronic prior authorization (ePA) requests online, use The Blue Cross name and symbol are registered marks of the Blue Cross Association. Use the formulary to search by drug name or disease category: For Medi-Cal drug coverage, please use the Medi-Cal Contract Drug List. We look forward to working with you to provide quality services to our members. This plan is closed to new membership. For more information, contact the plan. Tier assignments vary by plan. 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 . 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. Drugs not approved by the U.S. Food and Drug Administration (FDA). Dose optimization, or dose consolidation, helps you stick with your medicine routine. The benefit information provided is a brief summary, not a complete description of benefits. For more recent information or other questions, please contact Customer Care at 1-844-345-4577, 24 hours a day, 7 days a week. 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. Blue MedicareRx Value Plus (PDP) and Blue MedicareRx Premier (PDP) are two at a preferred pharmacy your copay is lower than what you would pay at a standard network pharmacy. In Connecticut: Anthem Health Plans, Inc. Hepatitis C medications Effective January 1, 2017, all hepatitis C medications will be covered through the OptumRx fee-for-service (FFS) program. Please call 844-336-2676 or fax all retail pharmacy PA requests to 858-357-2612 beginning July 1, 2021. The formulary, also known as a drug list, for each Blue MedicareRx plan includes most eligible generic and brand-name drugs. Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont Updates include changes to drug tiers and the removal of medications from the formulary. Change State. Massachusetts, Rhode Island, and Vermont. You should always verify cost and coverage information with your Medicare plan provider. In Kentucky: Anthem Health Plans of Kentucky, Inc. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. covered by Anthem. 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. The drug is prescribed at a higher dosage than recommended. (function() { That means we use a balanced approach to drug list/formulary management, based on a combination of research, clinical guidelines and member experience. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Sep 1, 2022 State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. They will work with the pharmacy and the Anthem HealthKeepers Plus plan to review your case and replace your medicines as needed. Prescription vitamins and minerals (except for prenatal vitamins and fluoride preparations). or union group and separately issued by one of the following plans: Anthem Blue Our. 2022 Formulary for Open Enrollment This is a list of drugs we will cover in 2023, including preferred and non-preferred drugs. area. 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. This list is for members who have the Medicare Supplement Senior SmartChoice plan. Call to speak with a licensed insurance agent and find plans in your area. MA-Compare: Review Changes in each 2021 Medicare Advantage Plan for 2022, Find a 2022 Medicare Part D Plan (PDP-Finder: Rx Only), Find a 2022 Medicare Advantage Plan (Health and Health w/Rx Plans), Q1Rx 2022 Medicare Part D or Medicare Advantage Plan Finder by Drug, Guided Help Finding a 2022 Medicare Prescription Drug Plan, Search for 2022 Medicare Plans by Plan ID, Search for 2022 Medicare Plans by Formulary ID, 2022 Medicare Prescription Drug Plan (PDP) Benefit Details, 2022 Medicare Advantage Plan Benefit Details, Pre-2020 Medicare.gov Plan Finder Tutorial, Example: AARP MedicareRx Preferred (PDP) Formulary in Florida, Learn more about savings on Pet Medications, ABACAVIR-LAMIVUDINE 600-300 MG TABLET [Epzicom], ABIRATERONE ACETATE 250 MG TABLET [ZYTIGA], Acamprosate Calcium DR 333 MG tablets [Campral], ACETAMINOPHEN-COD #3 TABLET [Tylenol with Codeine No.3], ACETAZOLAMIDE ER 500 MG CAPSULE ER [Diamox Sequels], ACETYLCYSTEINE 20% VIAL [Mucosil Acetylcysteine], ADEFOVIR DIPIVOXIL 10 MG TABLET [Hepsera], ADVAIR HFA 230; 21ug/1; ug/1 120 AEROSOL, METERED in 1 INHALER, ADVAIR HFA INHALER 115;21MCG;MCG 120 ACTN INHL, ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL, ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA], ALBUTEROL SUL 0.63 MG/3 ML SOLUTION VIAL-NEB [Accuneb], ALBUTEROL SUL 1.25 MG/3 ML SOLUTION VIAL-NEB, ALBUTEROL SUL 2.5 MG/3 ML SOLUTION VIAL-NEB, ALCLOMETASONE DIPR 0.05% OINTMENT [Aclovate], ALENDRONATE SOD 70 MG/75 ML SOLUTION [Fosamax], ALENDRONATE SODIUM 10 MG TABLET [Fosamax], ALENDRONATE SODIUM 35 MG TABLET [Fosamax], ALENDRONATE SODIUM 70 MG TABLET [Fosamax], AMILORIDE HCL-HCTZ 5-50 MG TABLET [Moduretic], Amino acids 4.25% in dextrose 10% Injectable Solution [Clinimix 4.25/10], Amino acids 4.25% in dextrose 5% Injectable Solution [Clinimix 4.25/5], AMLODIPINE BESYLATE 10 MG TABLET [Norvasc], AMLODIPINE BESYLATE 2.5 MG TABLET [Norvasc], AMLODIPINE BESYLATE 5 MG TABLET [Norvasc], AMLODIPINE-BENAZEPRIL 10-20 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 10-40 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 2.5-10 CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 5-10 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 5-20 MG CAPSULE [Lotrel], AMLODIPINE-BENAZEPRIL 5-40 MG CAPSULE [Lotrel], AMLODIPINE-OLMESARTAN 10-20 MG TABLET [AZOR], AMLODIPINE-OLMESARTAN 10-40 MG TABLET [AZOR], AMLODIPINE-OLMESARTAN 5-20 MG TABLET [AZOR], AMLODIPINE-OLMESARTAN 5-40 MG TABLET [AZOR], AMLODIPINE-VALSARTAN 10-160 MG TABLET [Exforge], AMLODIPINE-VALSARTAN 10-320 MG TABLET [Exforge], AMLODIPINE-VALSARTAN 5-160 MG TABLET [Exforge], AMLODIPINE-VALSARTAN 5-320 MG TABLET [Exforge], AMMONIUM LACTATE 12% CREAM (g) [Lac-Hydrin], AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE [Augmentin], AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET [Augmentin], AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE [Augmentin], AMOX-CLAV 400-57 MG/5 ML ORAL SUSPENSION [Augmentin], AMOX-CLAV ER 1,000-62.5 MG TABLET [Augmentin], AMOXICILLIN 200 MG/5 ML ORAL SUSPENSION [Amoxil], AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION [Trimox], AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [Amoxil], Ampicillin 1000 MG / Sulbactam 500 MG Injection, Ampicillin 125mg/1 10 VIAL, GLASS in 1 PACKAGE / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS, Anagrelide Hydrochloride 0.5mg/1 100 CAPSULE BOTTLE, APOMORPHINE 30 MG/3 ML CARTRIDGE [Apokyn], Apraclonidine 5 MG/ML Ophthalmic Solution, ARIPIPRAZOLE ODT 10 MG TABLET RAPDIS [Abilify Discmelt], ARIPIPRAZOLE ODT 15 MG TABLET RAPDIS [Abilify Discmelt], ASENAPINE 10 MG SUBLIGUAL TABLET [Saphris], ASENAPINE 2.5 MG TABLET SUBLIGUAL [Saphris], ASENAPINE 5 MG SUBLIGUAL TABLET [Saphris], ASPIRIN-DIPYRIDAM ER 25-200 MG CPMP 12HR [Aggrenox], ATAZANAVIR SULFATE 150 MG CAPSULE [Reyataz], ATAZANAVIR SULFATE 200 MG CAPSULE [Reyataz], ATAZANAVIR SULFATE 300 MG CAPSULE [Reyataz], ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT), ATOMOXETINE HCL 10 MG CAPSULE [Strattera], ATOMOXETINE HCL 100 MG CAPSULE [Strattera], ATOMOXETINE HCL 18 MG CAPSULE [Strattera], ATOMOXETINE HCL 25 MG CAPSULE [Strattera], ATOMOXETINE HCL 40 MG CAPSULE [Strattera], ATOMOXETINE HCL 60 MG CAPSULE [Strattera], ATOMOXETINE HCL 80 MG CAPSULE [Strattera], ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [Mepron], Atovaquone-Proguanil 250; 100mg/1; mg/1 [Malarone], AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION [Zithromax], AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [Zithromax], AZITHROMYCIN 250 MG TABLET [Zithromax Z-Pak], AZITHROMYCIN 500 MG TABLET [Zithromax Tri-Pak], AZITHROMYCIN 600 MG TABLET [Zithromax Z-Pak], AZITHROMYCIN I.V. 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