An official website of the State of Georgia. Browse Any 2022 Medicare Plan Formulary (Drug List), 2022 Medicare Part D and Medicare Advantage Plan Formulary Browser, Find a 2023 Medicare Advantage Plan (Health and Health w/Rx Plans), Browse Any 2023 Medicare Plan Formulary (or Drug List), Q1Rx Drug-Finder: Compare Drug Cost Across all 2023 Medicare Plans, Find Medicare plans covering your prescriptions, Medicare plan quality and CMS Star Ratings, Understanding Your Explanation of Benefits, IRMAA: Higher premiums for higher incomes, 2023 Medicare Advantage Plans State Overview, 2023 Medicare Advantage Plan Benefit Details, Find a 2023 Medicare Advantage Plan by Drug Costs. View a summary of changes here . Blue Shield of Vermont. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. var gcse = document.createElement('script'); Limitations, copayments, and restrictions may apply. Blue MedicareRx (PDP) is accepted coast-to-coast at national pharmacy chains and grocery retailers, plus thousands of community-based independent pharmacies. MedicareRx (PDP) plans. 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. s.parentNode.insertBefore(gcse, s); o If a drug you're taking isn't covered, your doctor can ask us to review the coverage. FormularyID, (Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2022 ). 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. ET, seven days a week. Your doctor can get the process started by calling the Pharmacy Member Services number on 2022 Medicare Part D Plan Formulary Information. If you need your medicine right away, you may be able to get a 72-hour supply while you wait. are Independent Licensees of the Blue Cross and Blue Shield Association, Anthem Blue Cross is the trade name of Blue Cross of California. Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont Use the Drug Pricing Tool to price the medications you are currently taking and see which Blue MedicareRx plan is best for you. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 598-0820-PN-NE. : 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 ). You can call a licensed agent directly at 1-866-831-1126 . : , . In some cases, retail drugs and supplies are covered under your Part B of Original Medicare medical benefit (e.g. 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. Your benefits include a wide range of prescription drugs. Featured In: All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members. We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. We work with CarelonRx to provide these pharmacy benefits. How to use the Anthem Blue Cross Cal MediConnect Formulary. : . 634-0920-PN-CONV. Generally, a drug on a lower tier will cost less than a drug on a higher tier. 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.) Drugs for cosmetic purposes or hair growth. Small Group 2023 Select Drug List (Searchable) | (PDF) Small Group 2022 Select Drug List (Searchable) | (PDF) Espaol. 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. Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont That way, your pharmacists will know about problems that could occur when you're . Well make sure you can get the quantity of medicines you need. 1-800-472-2689 (TTY : 711) . Drugs on the formulary are organized by tiers. If you dont have Adobe Acrobat Reader, you can download a free copy by clicking HERE. TTY 711 All other drugs are limited to a 34-day supply. Phone: 800-977-2273 or 711 for TTY. Enrollment in Blue Cross Blue Shield of Massachusetts depends on contract renewal. 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. The drug is prescribed at a higher dosage than recommended. 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 . PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. are preferred retail cost-sharing network pharmacies. Enrollment in Blue MedicareRx (PDP) depends on contract renewal. 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. : -, . Work with your pharmacist so you can stick to a medicine routine. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., The Anthem HealthKeepers Plus plan also covers many over-the-counter (OTC) medicines with a prescription from your doctor. Drugs for treatment of anorexia, weight loss or weight gain. This tool will help you learn about any limitations or restrictions for any rug. 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. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. Contact the Medicare plan for more information. Be sure to show the pharmacy your Anthem member ID card. This list only applies if you have a specialty pharmacy network included in your benefit. 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). Visit theAppeals & Grievancessection for more information. 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. 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. Those who disenroll This plan covers select insulin pay $35 copay. Attention Members: You can now view plan benefit documents online. Note: Not all prescriptions are available at mail order. Please note, this update does not apply to the Select Drug List and does not impact Medicaid and Medicare plans. These medications and supplies are available at network retail pharmacies. 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 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. (change state) How you know. English Spanish Don't see it listed? Updates include changes to drug tiers and the removal of medications from the formulary. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. 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. 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