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Medicare Plan Drug Formularies

Some Anthem Blue Cross and 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.

 

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1 Anthem “About Anthem, Inc.” (Accessed July 1, 2019). AnthemInc.com.

2 You must continue to pay your Part B premium. $0 premium plans may not be available in all areas.

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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. 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: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), which underwrites or administers the PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare Health Services Insurance Corporation (Compcare) underwrites or administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem websites constitutes your agreement with our Terms of Use.

Anthem-affiliated health plans are Medicare Advantage Organizations and Prescription Drug Plans with a Medicare contract. For Dual-Eligible Special Needs Plans: Anthem-affiliated health plans are a D-SNP with a Medicare contract and a contract with the state Medicaid program. Enrollment in Anthem-affiliated health plans depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The provider network may change at any time. You will receive notice when necessary.

For Dual-Eligible Special Needs Plans: This plan is available to anyone who has both Medical Assistance from the State and Medicare.

Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Call our Customer Service number, (TTY: 711). ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a nuestro número de Servicio de Atención al Cliente (TTY: 711). 注意:如果您使用非英語的其他語言,您可以免費獲得語言援助服務。請致電聯絡客戶服務部(聽語障用戶請致電:711)。

Y0114_19_111217_U Accepted 8/21/2019