Anthem Blue Cross Plans I, II, and III provide prescription drug benefits through CVS/Caremark. 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. CVS/Caremark Customer Care CVS Specialty Customer Care COVID-19 Resource Center 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. 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. 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). Any Network Retail Pharmacy Up to a 30-day supply: Maintenance Choice® (Filled at CVS/Caremark Pharmacy) Up to a 90-day supply:Non-Maintenance Medication (Retail Pharmacy)
Contact Information
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)
Register and refill: 800-237-2767
(M–F, 4:30 a.m.–6 p.m., Pacific Time)
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®)
Ninety-day supplies of
maintenance medications are available via mail order or Maintenance Choice®.Mail Order Service (Up to a 90-Day Supply)
CVS/Caremark Maintenance Choice®
Maintenance Prescription Medications Summary of Options
- 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