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Prescription Program
Formulary — To be used by members
who have a formulary drug plan.
Anthem Blue Cross and Blue Shield prescription drug benefits include medications
available on the Anthem Drug List/Formulary. Our prescription drug benefits can
• If you have additional
offer potential savings when your physician prescribes medications on the drug
list/formulary.
questions about your
prescription benefits please
QuesTions and answers
call the Member Services
number on your ID card
Q. What is a Drug List/Formulary?
a. The Anthem Drug List/Formulary is a list of FDA-approved brand-name and
• Speech and hearing impaired
generic medications that have been reviewed and recommended for their (TDD/TTy users) should
quality and effectiveness by the National Pharmacy and Therapeutics (P&T) call 800-221-6915,
Committee. The P&T Committee is an independent group of practicing doctors Monday – Friday,
and pharmacists responsible for the research and decisions surrounding 8:30 a.m. – 5:00 p.m., eT
our drug list. This group meets regularly to review new and existing drugs and choose the top medications for our drug list—based on their safety, • For the most current version
of this prescription drug list,
Because the medications on the drug list/formulary are subject to periodic please visit anthem.com
review, please ask your physician about the most current drug list additions Bring a copy of this drug
list/formulary to your next
Brand-name: A brand-name drug is usually available from only one
doctor’s visit to assist in
manufacturer and may have patent protection. selecting the lowest cost
Generic: A generic drug is required by the FDA to have the same active
medications
ingredients as its brand-name counterpart, but is normally only available after the patent protection expires on a brand-name drug. Although it may look different, a generic drug works the same as its brand-name counterpart. You can save money by using generic medications. Q. What are ‘clinically equivalent’ medications? How does this affect my drug
coverage?
a. The P&T Committee reviews the most current research available to determine
if multiple drugs used to treat a disease/condition produce the same clinical effect. When this is the case, the committee may recommend that we cover only the lower cost drug(s) as part of our effort to help reduce the overall cost of care. This means your specific prescription plan may not cover some drugs (indicated by a ^ symbol next to the drug name) in classes with ‘clinically equivalent’ alternatives.
Q. What if my medication is not on the drug list/formulary?
a. An open drug list allows members and their physicians to choose from a
wide variety of prescription medications. Please talk with your doctor about Generic Medications
prescribing a medication that is on the drug list/formulary. If a medication is selected that is not on the drug list/formulary, you will be responsible for the Brand-name Medications
You or your physician may submit a request to add a drug to the drug list/formulary either in writing or on our web site. Requests are taken into consideration by the P&T Committee during the drug list/formulary review process. Inclusion of a medication on the drug list/formulary is not a guarantee of coverage. Some drugs, such as those used for cosmetic purposes, may be excluded from your benefits. Please refer to your Certificate or Evidence of Coverage for coverage limitations and exclusions.
Generic Medications
Brand-name Medications
Generic Medications
Brand-name Medications
Generic Medications
Brand-name Medications
Anthem is committed to helping you to manage your prescription benefits. Prior Authorization, Quantity Limits, Step Therapy and Dose Optimization are some of the edits recommended by the P&T Committee and approved by your health plan. These edits help ensure you have access to safe, appropriate and effective prescription medications.
PRIOR AUTHORIZATION: medications which require pharmacy benefit manager or plan approval
before you may receive benefits.
QUANTITy LIMIT: affects the frequency or dosage of certain medications for which you receive
benefits.
STeP THeRAPy: requires that you first use a specific medication before alternatives therapies may
be tried or prescribed.
DOSe OPTIMIZATION: normally involves the conversion from twice-daily dosing to a once-daily dosing
schedule. A once-daily dosing schedule may increase compliance and decrease expenses for you
and your health plan.
Medications in the following categories are included in the dose optimization edits.
Antidepressants Not all medications and not all plans are subject to prior authorization and quantity limits. For more information regarding prior authorization or quantity limits, contact Member Services at the telephone number listed on your identification card.
^ This product has clinical y equivalent alternatives included on the formulary and, as a consequence, such product may not be covered under your pharmacy benefit. Please consult your on-line pharmacy account through your health plan website, anthem.com, for details on coverage.
For Kentucky Residents Only:
In selecting medications for the prescription drug formulary, the therapeutic efficacy and cost effectiveness are addressed for each category. All therapeutic
categories are represented on the formulary by at least one medication. When a closed formulary is in effect, only medications that are included on the formulary are
a covered service. In certain clinical situations, a member may require use of a non-formulary product. Anthem has criteria that permits a member to obtain a non-
formulary medication in a closed formulary plan. If specific criteria are met, a member can receive a non-formulary drug for a formulary copay. The criteria preserves
the clinical integrity of the drug formulary and provides a process by which deviations from the formulary may be allowed. An appeals process is in place for any
medications that do not meet the criteria.
For more information, please visit anthem.com.
• If you have additional questions about your prescription benefits
please call the Member Services number on your ID card
• Speech and hearing impaired (TDD/TTy users) should
call 800-221-6915, Monday – Friday, 8:30 a.m. – 5:00 p.m., eT
• For the most current version of this prescription drug list,
please visit anthem.com
• Bring a copy of this drug list/formulary to your next doctor’s visit
to assist in selecting the lowest cost medications
Life and Disability products are underwritten by Anthem Life Insurance Company. In Colorado: Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. In Indiana: Anthem Blue Cross and Blue Shield is a trade name of Anthem Insurance Companies, Inc. In Kentucky: Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. In Missouri: Anthem Blue Cross and Blue Shield is the trade name RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC) and HMO Missouri, Inc. use to do business in most of Missouri. 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. In Nevada: Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. In Ohio: Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. In Wisconsin: Blue Cross Blue Shield of Wisconsin (“BCBSWi”) under-writes or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (“Compcare”) underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® Blue Cross and Blue Shield are registered marks of the Blue Cross and Blue Shield Association.

Source: http://alexionadvantage.com/Images/files/Anthem%20Formulary.pdf