2025 Anthem Medicare Plan Drug Formularies
Some Anthem Blue Cross Blue Shield (Anthem) Medicare Advantage Plans offer prescription drug coverage.
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.
Learn more about Medicare formularies and find an Anthem Medicare Advantage Plan available near you that offers prescription drug coverage.
What is a Medicare plan drug formulary?
A formulary is a list of drugs that are covered by the plan. Formularies are typically broken down into different tiers.
Generic, low-cost drugs are typically grouped into lower tiers, while more expensive brand-name drugs can be found in higher tiers. Each plan may feature a slightly different formulary.
A licensed insurance agent can help you find out if your medications are covered by an Anthem Medicare Advantage Plan in your area.
What is Step Therapy?
There may be different drugs that are designed to treat the same condition but are on different tiers of a Medicare plan formulary. This means that one drug may cost more than the other, though they are used for the same treatment.
Step therapy is when a patient and doctor both agree to try the lower-cost drug first, and only “step up” to more expensive drugs if necessary.
Do I need prior authorization for my covered drugs?
For certain drugs, a Medicare plan may require you to get prior authorization from your doctor to confirm the drug is medically necessary for you.
Your doctor can work with you to complete the appropriate prior authorization form.
Do Anthem Medicare plans with drug coverage include quantity limits?
Your Medicare plan may limit the amount of a specific drug you can get or how soon you may refill a prescription.
Quantity limits are designed to keep you safe, and you can work directly with your plan and your doctor to find out how your drugs are covered.
Do Medicare drug plans offer exceptions?
With a Medicare plan that covers prescription drugs, you have the right to ask for exceptions from quantity limits or step therapy. You may also be able to request lower copayments for specific drugs.
Talk with your doctor if you want to ask for an exception with your drug plan.
Medication Therapy Management
Medication Therapy Management (MTM) is a program that helps Anthem Medicare Plan members with multiple health conditions better understand their medications.
Program members receive regular medication reviews and action plans and may speak directly to pharmacists about their conditions and drugs.
The MTM program is free to qualifying members.
How much do Anthem Medicare plans that cover drugs cost?
Medicare Advantage plans that cover prescription drugs may feature monthly premiums, annual deductibles, copayments or coinsurance and an annual coverage limit.
Some plans may offer $0 deductibles or $0 premiums.2
Find an Anthem Medicare Advantage plan that covers prescription drugs
Call a licensed insurance agent at 1-866-870-3072, TTY 711, 24/7 to find Medicare Advantage Plans in your area that offer prescription drug coverage.
