However, the drug list is not intended to be a substitute for a doctor's clinical knowledge and judgment. This plan is closed to new membership. gcse.type = 'text/javascript'; are the legal entities which have contracted as a joint enterprise with the Centers The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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. View a summary of changes here . It features low $1 copays for tier 1 prescription drugs. These kinds of medicines arent paid for by your plan: Click here to see the list of medications available for 90-day supply. Prior authorization phone and fax numbers All prior authorizations will be managed by MedImpact. 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. Drugs on the formulary are organized by tiers. Limitations, copayments, and restrictions may apply. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. View a summary of changes here . 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. If you misplace your medicine or it is stolen, contact your provider. The formulary, also known as a drug list, for each Blue MedicareRx plan includes most eligible generic and brand-name drugs. Change State. You must continue to pay your Medicare Part B premium. as required by Medicare. are the legal entities which have contracted as a joint enterprise with the Centers To request a printed copy of our pharmacy directory call us, 24 hours a day, 7 days a week. These medications and supplies are available at network retail pharmacies. To find a pharmacy near you, use our pharmacy locator tool. Use of the Anthem Web sites constitutes your agreement with our Terms of Use. 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. Call 1-800-472-2689 (TTY: 711). ET, Monday through Friday. The preapproval process helps us make sure that youre taking medications safely and correctly. These drugs have been chosen for their quality and effectiveness. Updates include changes to drug tiers and the removal of medications from the formulary. Pharmacy services billed as a medical (professional) or institutional claim (or their electronic equivalents) are not in scope. How to use the Anthem Blue Cross Cal MediConnect Formulary. Attention Members: You can now view plan benefit documents online. Anthem Blue Cross is the trade name of Blue Cross of California. It is for a higher supply of medicine than our standard 34-day supply. Availity. 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 . This process is called preapproval or prior authorization. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Reminder: Use Diagnosis Codes On All Pharmacy PA Requests. Drugs on the formulary are organized by tiers. You pay nothing for these drugs and supplies covered under your Original Medicare medical benefit. LU . Medallion Medicaid/FAMIS: 1-800-901-0020 o You can search for generic drugs at anthem.com. This list only applies if you have a specialty pharmacy network included in your benefit. Blue MedicareRx formularies may change during a calendar year if we remove a drug, change a drugs tier, We make receiving prescriptions as convenient as possible. Dietary supplements, except for treatment of phenylketonuria (PKU). An independent group of practicing doctors, pharmacists and other health-care professionals meet often to look at new and existing drugs. 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. We may not tell you in advance before we make that change-even if you Important Information About Vaccines and Insulin To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). 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. This ensures that our members use these drugs in a safe way. Formularies 2023 FEP Blue Focus Formulary View List 2023 Basic Option Formulary View List 2023 Standard Option Formulary View List Drug tiers Express Scripts develops formularies based on the following principles: 1. for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue 2023 All Rights Reserved. Also, when 500 MG VIAL [Zithromax], Everyone in your household can use the same card, including your pets. 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. . When you fill your prescription at a preferred pharmacy your copay is lower . Sometimes, we must remove a drug immediately for safety reasons or due to its discontinuation by the manufacturer. Blue MedicareRx Value Plus (PDP) and Blue MedicareRx Premier (PDP) are two Those who disenroll The final decision for a patient's drug therapy always rests with the physician. Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont An Anthem Medicare Advantage Plan that covers prescription drugs will include a formulary, which is a list of drugs that are covered by the plan. Visit thePrior Authorization and Step Therapysection for more information. 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. S2893_2209 Page Last Updated 10/15/2022. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag1-800-472-2689(TTY: 711 ). 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. : -, . 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. Changes to drug tiers and the removal of medications available for 90-day supply, including your pets pharmacy billed. Members use these drugs have been chosen for their quality and effectiveness in your can! 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