NY pharmacy and prescription drug benefits
Your Anthem Blue Cross and Blue Shield HP plan may cover a wide range of prescription drugs in New York. We work with CarelonRx to provide these benefits.
Getting your prescriptions through NYRx is easy
Beginning April 1, 2023, all Medicaid members enrolled in Anthem will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program.
Be sure to review information about the transition of the pharmacy benefit from Anthem to NYRx.
You can also review general information about NYRx, review NYRx information for members, or review NYRx information for providers.
For Child Health Plus and Essential Plan members, we offer a wide range of prescription and over-the-counter (OTC) drugs, home delivery, and other pharmacy services. We work with CarelonRx to provide these benefits.
To find a pharmacy near you, use our pharmacy locator tool.
Medications straight to your doorstep
With the ZipDrug pharmacy program, you’ll get customized care at no extra cost. ZipDrug will connect you with a participating local pharmacy. The pharmacy will package your medications by time and day to help you understand what to take and when. They’ll also schedule free hand-delivery. You may even qualify for one-on-one support from the local pharmacy. They’ll create a personalized care plan to help manage your medications and health conditions.
Here’s how it works:
- Call to enroll at 844-947-3784 Monday through Friday, 9 a.m. to 5:30 p.m. Eastern time.
- Your prescriptions will be transferred by your participating local pharmacy. They’ll package your medications by time and day and set up refills so they’re on the same schedule.
- Receive your prescriptions by scheduled hand-delivery, at no extra cost. When your prescriptions are ready, the pharmacy will call you to schedule delivery for a day and time that’s most convenient.
Copays
Copays are a set dollar amount you pay for a covered service, like getting a prescription filled.
Essential Plan members
There may be copays for your prescriptions. Check your member handbook to find out if your plan has copays.
Medicaid and HARP members
Starting April 1, 2023, your prescriptions will not be covered by Anthem. They will be covered by Medicaid NYRx, the Medicaid pharmacy program.
CHPlus members
There are no copays for covered drugs.
MLTC and MAP members
Your pharmacy benefits are not covered through Anthem. You either get these services through Medicare or through fee-for-service Medicaid.
Find out if your prescription is covered
Anthem has a list of preferred drugs chosen for their quality and effectiveness. It’s called a Preferred Drug List (PDL).
Many of the drugs listed on the PDL do not need preapproval. Drugs not listed on the PDL always require preapproval. This means your doctor must get approval from us before they can write a prescription for the drug. Go to the preapprovals section below for more information.
The PDL can change at any time. Please check back for updates.
Essential Plan members:
Essential Plan Preferred Drug List (English)
Essential Plan Preferred Drug List (Spanish)
CHPlus members:
CHPlus Preferred Drug List (English)
CHPlus Preferred Drug List (Spanish)
The formulary is a list of all brand-name and generic drugs available in your plan. It lists both drugs found on the PDL and others not listed on the PDL. Use our searchable formulary to search for drugs by:
- Typing the name of the drug in the search box.
- Using the A to Z list to search by the first letter of the drug name.
- Clicking the therapeutic class of the drug. their website.
Don’t see it listed?
If you need to take a drug not listed in the formulary, you may request an exception at submitmyexceptionreq@anthem.com. You’ll be asked to supply a reason why it should be covered, such as an allergic reaction to a drug.
Managing your prescription
Some medicines need a preapproval, or an OK, from us before your doctor can prescribe them. Drugs that require preapproval will be listed with PA next to the drug name. For those medicines, your doctor must get preapproval before you can fill your prescription. Your doctor can get this by calling our Pharmacy department.
Drugs that require preapproval include those that:
- Have high side-effect potential
- Should be prescribed only for specific usage
- Have high misuse or abuse potential
- May cost more than other preferred drugs
The preapproval process helps us make sure you’re taking medicines safely and correctly.
Other times you may need preapproval are:
- When requesting a higher dosage than recommended
- When requesting a brand-name drug that already has an FDA-approved generic version
- When the drug is part of a step therapy treatment plan. Step therapy means trying less expensive options before "stepping up" to drugs that cost more.
Specialty pharmacy
Get your specialty medications
If you have a specialty condition, you have the option to use CarelonRx Specialty Pharmacy for your specialty medication needs. We partner with CarelonRx Specialty Pharmacy and other pharmacies to meet all your specialty medication needs.
