Anthem blue cross blue shield prescription coverage

Q: Do I need Medicare Part D if I dont take any drugs?

Do I need Medicare Part D drug coverage if I dont take any prescriptions? En español | If you dont have other drug coverage thats considered creditable,” meaning at least as good as Part D, the answer is yes.

Anthem Blue Cross Plans I, II, and III provide prescription drug benefits through CVS/Caremark.

Table of Contents Show

Non-Maintenance Medication (Retail Pharmacy)
Contact Information
Retail Pharmacy Purchase Information
Maintenance Medication (Mail Order and Maintenance Choice®)
Mail Order Service (Up to a 90-Day Supply)
CVS/Caremark Maintenance Choice®
Maintenance Prescription Medications Summary of Options
Specialty Prescription Drugs
Do I need Medicare Part D if I don't take any drugs?
Who is the PBM for Anthem BCBS of Indiana?
How do I contact Anthem Blue Cross California?
What is the purpose of generic names and numbers in Anthem?

Non-Maintenance Medication (Retail Pharmacy)

Short-term medications, up to a 34-day supply, are available at network retail pharmacies. CVS/Caremark’s network includes more than 68,000 pharmacies nationwide, including chain pharmacies and CVS/Caremark Pharmacy locations. Present your Anthem Blue Cross ID card with CVS/Caremark information on the back to a pharmacist, along with each prescription, to ensure correct claims processing.

Contact Information

CVS/Caremark Customer Care
800-450-3755
www.caremark.com
(log in with your member ID number, located on the back of your Anthem Blue Cross I, II, or III ID card)

CVS Specialty Customer Care
Register and refill: 800-237-2767
(M–F, 4:30 a.m.–6 p.m., Pacific Time)

COVID-19 Resource Center

Contact your insurance carrier for plan booklets, claim forms, and billing questions.

Retail Pharmacy Purchase Information

In-NetworkYou pay for your prescription when you receive your medication. The pharmacy will calculate the 20 percent coinsurance at the time of purchase, after applying your deductible. Plan III does not have a deductible.Non-Network PharmacyYou submit a claim form directly to Caremark for reimbursement. Anthem Blue Cross reimburses you for 60 percent of reasonable and customary charges, after applying your deductible. Plan III does not have a deductible.If you do not live within the CVS/Caremark service area, you will be reimbursed for 80 percent of reasonable and customary charges, after applying your deductible. Plan III does not have a deductible.

Maintenance Medication (Mail Order and Maintenance Choice®)

For participants who take maintenance prescriptions for chronic medical conditions and specialty drugs. A maintenance medication is one taken regularly for chronic conditions or long-term therapy, such as managing high blood pressure, asthma, diabetes, or high cholesterol.
Ninety-day supplies of maintenance medications are available via mail order or Maintenance Choice®.

Mail Order Service (Up to a 90-Day Supply)

You receive up to a 90-day supply of maintenance medications for one small copayment (no deductible is required). Obtain a 90-day supply maintenance prescription from your doctor and have it filled through Mail Order. Approximately 10 to 14 days after CVS/Caremark receives your order, you will receive your prescriptions in the mail, along with information about your medications, a receipt, and a new order form.

CVS/Caremark Maintenance Choice®

30-day fills of maintenance medications can be filled (no fill limits) at any participating CVS/CAREMARK network pharmacy. You will pay the 20 percent retail coinsurance after you meet the annual deductible.

90-day fills of maintenance medications can be filled at CVS pharmacies (including those inside Target stores) or through Mail Order service. Using these options, you pay the copay amounts ($10 – Generic Drugs, $30 Preferred brand drugs, $50 Non-preferred brand drugs).

Maintenance Prescription Medications Summary of Options

Any Network Retail Pharmacy Up to a 30-day supply:

Generic Drugs, Preferred Brand Drugs and Non-Preferred Brand Drugs require 20 percent coinsurance*
Fill limit for long-term medications have no limit

Maintenance Choice® (Filled at CVS/Caremark Pharmacy) Up to a 90-day supply:

Generic drugs - $10 copay
Preferred brand drugs - $30 copay
Non-preferred brand drugs - $50 copay
Fill limit for long-term medications have no limit

Mail Order Service Up to a 90-day supply

Generic drugs - $10 copay
Preferred brand drugs - $30 copay
Non-preferred brand drugs - $50 copay
Fill limit for long-term medications have no limit

*After you meet the annual deductible. Note: Anthem Blue Cross Plan III does not have deductibles.

Specialty Prescription Drugs

Specialty prescription drugs are used to treat complex or rare conditions, such as rheumatoid arthritis, osteoporosis, cancer, anemia and multiple sclerosis. Specialty prescription drugs are available only by mail through Caremark Specialty Pharmacy Services, unless they are dispensed in your physician’s office. To fill your prescription, you must register with Caremark Specialty Pharmacy Services by calling 800-237-2767. Your applicable plan design copay will apply.

Specialty Prescription Drugs Benefit Copays

$150 copay mail order only (3-month supply)
1–30-day supply — $50
31–60-day supply — $100
61–90-day supply — $150

Anthem Blue Cross (Anthem) Formulary

The medications included in the Anthem formulary are reviewed and approved by the Pharmacy and Therapeutics Committee, which includes Practitioners and Pharmacists from the Provider community.

Please select a drug from the list below to see all coverage details regarding the medication. Some medications listed may have additional requirements or limitations of coverage. These requirements and limits may include prior authorization, quantity limits, age limits, step therapy or Center for Medicare and Medicaid Services (CMS) coverage requirements.

Medications not listed on the formulary are considered to be non-formulary and are subject to prior authorization.

Additionally, if a medication is available as a generic formulation, this will be Anthem's preferred agent, unless otherwise noted. If you have any questions about coverage of a certain product, please contact us at 1-844-410-0746.

Machine Readable Data for Prescription Drug Formulary: Anthem BlueCross Medicaid Managed Care Machine Readable File

Do I need Medicare Part D if I don't take any drugs?

Do I need Medicare Part D drug coverage if I don't take any prescriptions? En español | If you don't have other drug coverage that's considered “creditable,” meaning at least as good as Part D, the answer is yes.

Who is the PBM for Anthem BCBS of Indiana?

Earlier this year, we announced the launch of IngenioRx, our new pharmacy benefits manager (PBM). Effective January 1, 2020, IngenioRx will start serving our Anthem Blue Cross members' prescription drug coverage.

How do I contact Anthem Blue Cross California?

Care Management support is available 24/7 through Anthem Blue Cross Cal MediConnect Plan Customer Care at 1-855-817-5786.

What is the purpose of generic names and numbers in Anthem?

The characters are identified by social concepts and digits. The citizens' names mirror the collectivism of the society and are so impersonal that they eliminate all trace of individualism, names like Equality 7-2521, Liberty 5-300, Collective 0-0009, Unanimity 7-3304, etc.

anthem blue cross blue shield prescription coverage