Drug Benefit Exclusion

 

For many plans administered by Anthem Prescription Management, the Health Plan prescription benefits may exclude benefits for any new FDA Approved Drug Product or Technology (including but not limited to medications, medical supplies, or devices) available in the marketplace for dispensing by the appropriate source for the product or technology, including but not limited to Pharmacies, for the first six months after the product or technology received FDA New Drug Approval or other applicable FDA approval.  

 

Not all states in which Anthem operates have the New Drug Benefit Exclusion. Currently, this exclusion is in place for some plans in Ohio, Kentucky, Indiana, New Hampshire, Colorado, and Nevada. Furthermore, specific employer groups in these states may have elected not to adopt the new drug benefit exclusion. Please refer to your Certificate or Evidence of Coverage for coverage limitations and exclusions. Please call the Member Service number on your ID card if you have additional questions about your prescription program.