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). IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. are replacing it with a new generic drug that will appear on the same or Non-prescription drugs (also called over-the-counter drugs). To request a printed copy of our pharmacy directory call us, 24 hours a day, 7 days a week. 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.) 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. Change State. For all medically billed drug (Jcode) PA requests, please continue to send those directly to Anthem for review. Your Medicare Part D prescription benefit is a 5-tier structure. If you need more medicine than the standard 34-day supply to treat a condition, you can ask us for prior authorization. Select your search style and criteria below or use this example to get started Type at least three letters and we will start finding suggestions for you. (change state) Use the Drug Pricing Tool to price the medications you are currently taking and see which Blue MedicareRx plan is best for you. 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. PlanID 2022 Formulary for Open Enrollment This is a list of drugs we will cover in 2023, including preferred and non-preferred drugs. Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). pharmacies in our network, over 22,000 CCC Plus: 1-855-323-4687 Limitations, copayments, and restrictions may apply. Limitations, copayments, and restrictions may apply. 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. An official website of the State of Georgia. New! , 1-800-472-2689(: 711 ). 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. for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue Type at least three letters and well start finding suggestions for you. Your benefits include a wide range of prescription drugs. Important Message About What You Pay for Insulin - You wont pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier its on even if you havent paid your deductible, if applicable. Your doctor can prescribe most of these medicines to you without getting preapproval or an OK from us. Providers may need to get approval from MedImpact for certain drugs. That means we use a balanced approach to drug list/formulary management, based on a combination of research, clinical guidelines and member experience. D77 bee an7tah7g7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689(TTY: 711). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult. Electronic prescribing, or e-Prescribing, lets the doctor who prescribes your medicines send your information right to a retail or mail-order drugstore in your plan. 1-800-472-2689 (TTY : 711) . This ensures that our members use these drugs in a safe way. 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. Note: For Synagis or other medical injectable drug prior authorizations, please call 1-866-323-4126. There may be some physician administered medical injectable drugs that require approval from Anthem before a prescription can be filled. Anthem MediBlue Rx Plus (PDP) (S5596-057-0) Benefit Details. Search by: State & Plan All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members. That way, your pharmacists will know about problems that could occur when you're . control costs. })(); This is archive material for research purposes. Also, when We make every attempt to keep our information up-to-date with plan/premium changes. Contact the plan provider for additional information. 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. A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Be sure to show the pharmacy your Anthem member ID card. If you use another pharmacy, you should tell the pharmacist about all medicines you are taking. Our Medication Synchronization program (Med Sync) makes getting all your medicines easier at no extra cost to you. ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement. 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. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Express Scripts develops formularies based on the following principles: 1. Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont If you have the PreventiveRx Drug List (Preferred), please refer to the PreventiveRx Plus Drug List (National) above. Our. All drugs on the formulary are covered, but many require preapproval before the prescription can be filled. There are other drugs that should be tried first. Compare Anthem Part D Plans MediBlue Rx* Standard Part D Plan This plan is a good choice if you take fewer medications. In certain situations, you can. 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). To submit electronic prior authorization (ePA) requests online, use Have more questions about Med Sync? : , , : .. Important Information About Vaccines and Insulin MedicareRx (PDP) plans. Please call 844-336-2676 or fax all retail pharmacy PA requests to 858-357-2612 beginning July 1, 2021. Sep 1, 2020 See individual insulin cost-sharing below. These drugs have been chosen for their quality and effectiveness. 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). Getting your prescriptions filled is easy. How to use the Anthem Blue Cross Cal MediConnect Formulary. Massachusetts, Blue Cross & Blue Shield of Rhode Island, and Blue Cross and To submit electronic prior authorization (ePA) requests online, use Availity. If you're not sure whether these lists apply to your plan, check with your employer or call the Pharmacy Member Services number printed on your ID card. Blue MedicareRx (PDP) Premier (PDF). Those who disenroll Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. This list of specialty medications is not covered under the pharmacy benefit for certain groups. (Updated 02/01/2023) You must continue to pay your Medicare Part B premium. Coverage is available to residents of the service area or members of an employer Attention Members: You can now view plan benefit documents online. To request a drug be added to the Preferred Drug List (PDL), please contact Anthem via the. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. 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. Enrollment in Blue MedicareRx (PDP) depends on contract renewal. We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. If youre interested in saving money on your prescriptions, discuss with your doctor whether switching to a similar drug on a Through Anthem, SHBP offers eligible members, including pre-65 Retirees a choice of three Health Reimbursement Arrangement (HRA) Plan Options: Gold HRA, Silver HRA . are Independent Licensees of the Blue Cross and Blue Shield Association, You can log in to your account and manage your prescriptions filled through home-delivery pharmacy. Use of the Anthem websites constitutes your agreement with our Terms of Use. 500 MG VIAL [Zithromax], Everyone in your household can use the same card, including your pets. 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. See how we help keep your out-of-pocket costs low for the medications you and your family need. Sep 1, 2022 ATANSYON: Si ou pale kreyl ayisyen, svis asistans nan lang disponib pou ou gratis. 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. We do not sell leads or share your personal information. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. are the legal entities which have contracted as a joint enterprise with the Centers Drugs for treatment of anorexia, weight loss or weight gain. The Anthem MediBlue Rx Plus (PDP) (S5596-057-0) Formulary Drugs Starting with the Letter A. in CMS PDP Region 16 which includes: WI. Blue Cross and Blue Shield of Massachusetts is an HMO and PPO Plan with a Medicare contract. When you fill your prescription at a preferred pharmacy your copay is lower . : , , . Customer Support Visit thePrior Authorization and Step Therapysection for more information. 1-800-472-2689(TTY: 711). 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. 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. Providers who do not contract with the plan are not required to see you except in an emergency. Note: Not all prescriptions are available at mail order. October 1 through March 31, 8:00 a.m. to 8:00 p.m. Simply take your written prescription to a plan pharmacy or ask your doctor to call it in. or union group and separately issued by one of the following plans: Anthem Blue Do not sell or share my personal information. To find a pharmacy near you, use our pharmacy locator tool. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service Blue MedicareRx (PDP) is a Prescription Drug Plan with a Medicare contract. 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. Updates include changes to drug tiers and the removal of medications from the formulary. 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