Prescriptions And Pharmacies

Anthem plans cover brand name and generic drugs, and specialty drugs if you have an ongoing health issue or serious illness. You also have plenty of choices for how and where you fill prescriptions.

 

Find out if a medication you take is on the Drug List.

 

What’s Covered?

 

Our plans cover:

 

 Brand name and generic drugs on your drug list.

 

 Some preventive drugs at low or no cost to you.

 

 Most specialty drugs if you have an ongoing health issue or serious illness.

 

Drug List (Formulary)

 

Your plan uses the Essential Drug List. Use this searchable drug list if you want to check the list for a medication you take. If your drug is not on the list, you’ll see other options. We may make changes to the drug list, so always check it before you fill or refill a prescription.

Tiers

 

Drugs on this list are grouped in tiers (groups). Your share of the cost depends on which tier your drug is on. The lower the tier, the lower your cost.

 

More about the drug list

 

Some medications require certain steps before your plan covers them. Here are a few you need to know about:

 

 Prior authorization (PA). This is also called preapproval. We may need to approve your prescription before a pharmacy can fill it.

 

 Step therapy (ST). You may need to try one or more other drugs before your plan will cover the one your doctor wants you to take.

 

 Quantity limits (QL). Your plan may limit how much of a medicine you can get each month to help protect your health.

Find A Pharmacy

 

You'll have plenty of choices about how and where to fill your prescriptions, including local pharmacies in your plan and convenient home delivery.

Retail pharmacies

 

Our plans include two levels of pharmacies. Your cost is lowest when you use one of the more than 25,000 pharmacies on Level 1, including chains like CVS, Target, Kroger, Walmart, and Costco. You can also use one of the 45,000+ Level 2 pharmacies. Your prescriptions will still be covered, but you'll pay more.

Home delivery

 

If you take medicines regularly or need them on a long-term basis, you can save time with home delivery. You may also save money. You can have up to a 90-day supply delivered to your door, with free standard shipping. Sign up by calling 833-236-6196 or use the mail-order form on anthem.com.

Specialty pharmacy

 

If you have a complex health condition that requires specialty drugs for your treatment ― drugs that need special handling or that you receive by injection or infusion ― you'll need to fill your prescriptions through CarelonRx Specialty Pharmacy.* You may also be able to choose other specialty pharmacies in the plan’s network.

* CarelonRx is an independent company providing pharmacy benefit management services on behalf of Anthem Blue Cross and Blue Shield.

Save On Drug Costs

 

Here are some things you can do to save money on your drug costs:

 

 Take medicines on your plan’s drug list.

 

 Choose drugs on Tier 1 for the lowest cost.

 

 Find out if there are generic or over-the-counter options that may work for you.

 

 Compare drug costs with our Price a Medication tool at anthem.com.

 

 Use a pharmacy in your plan. Save more by filling your prescription at a Level 1 pharmacy.

 

 Get 90-day supplies of the medicines you take regularly. Remember to always talk to your doctor before making any change in your medicine.

 

 How to save on drug costs

Manage Your Benefits On Sydney Health Or Anthem.com

 

Once you've selected your plan and enrolled, download Sydney Health or register at anthem.com. It's the fastest and easiest way to keep track of your benefits and prescriptions.

 

You can do things like:

 

 Find a pharmacy in your plan’s network.

 

 Check your drug list.

 

 Compare drug costs.

 

 Check your claims status and history.

 

 Check your copay, deductible, or percentage of the cost for your medicine.