Anthem Blue Cross : Pharmacy information for Healthy Families HMO members

Pharmacy information for Healthy Families HMO members

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Healthy Families Program - HMO Pharmacy Information 
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Prescription Drug Benefits  
Anthem Blue Cross pays for most of the drugs your provider will prescribe. There are two kinds of drugs: brand-name and generic. A brand-name drug is a drug that is made by one company. Generic drugs are approved by the Food and Drug Administration (FDA) and they are as safe and effective as brand-name drugs. Generic drugs require the same tests as brand-name drugs, and are therapeutically equal to the brand drug. Most of the time you can get brand-name and generic drugs at the same pharmacy. 
In general, brand-name prescription drugs are covered only if there is no generic drug available. We may pay for brand-name drugs in cases where your provider writes on the prescription that you need the brand-name drug.  
 
Where to Get Your Prescriptions Filled  
You can fill your prescriptions at more than 4,400 retail pharmacies in California. If you want to check if a certain pharmacy works with Anthem Blue Cross or if a drug is covered, call Anthem Blue Cross’ prescription drug plan at 1-800-700-2533. The TTY number for members with hearing or speech loss is 1-800-905-9821. You can also access our printable drug lists by visiting the Forms Library on your health plan site. To access the Forms Library: 

Visit anthem.com/ca

Select the Customer Care tab on the upper right side of the homepage

On the resulting page, select Download Forms

 
When you get your prescriptions filled through a retail pharmacy, you will be given no more than a 30-day supply. You may get refills if your doctor wrote your prescription with refills. When you get your prescription filled through home delivery, you will receive a 90-day supply. If you have questions or need a home delivery order form, visit the Express Scripts website. To access the Express Scripts website, select Refill a Prescription after login to your health plan website. The home delivery order form is located in the Fill a New Prescription section. 
You can also call Anthem Blue Cross’ prescription drug plan at 1-800-700-2533. 
 
Anthem Blue Cross uses a chosen list of drugs called a “preferred drug list.” A group of doctors and pharmacists updates this drug list every three months. Updating this list helps to make sure that the drugs on it are safe and useful. Even though a drug is on the list, your provider will decide which drug is best for you.  
If you would like to know if a drug is on the preferred drug list, call 1-800-700-2533. Members with hearing or speech loss may call the TTY line at 1-800-905-9821. You can also find our printable drug lists by visiting the Forms Library on your health plan website. 
To access the Forms Library: 

Visit anthem.com/ca

Select the Customer Care tab on the upper right side of the homepage

On the resulting page, select Download Forms

 
Cost to Member 
Anthem Blue Cross pays most of the cost for your prescribed drugs. You only pay a small amount. This is called a copay.  
Below are the copay amounts for most prescribed drugs you can get at a retail pharmacy or through home delivery: 
$5 per prescription for up to a 30-day supply for brand-name or generic drugs including smoking cessation drugs from a retail pharmacy
$5 per 90-day supply of maintenance drugs supplied through home delivery
Maintenance drugs are prescribed for 60 days or longer and are usually prescribed for chronic conditions such as arthritis, heart disease, diabetes or hypertension. 
No copay for FDA-approved contraceptive drugs or devices
Keep all receipts from doctor visits and prescriptions for all of your family members in the Healthy Families Program. As soon as you reach the yearly dollar total as outlined in your Member Handbook, send copies of the receipts to Anthem Blue Cross at the address on your Anthem Blue Cross ID card. You will still need to pay copays until we get proof that you have reached the required yearly dollar amount.
 
Some Drugs Need an OK from Anthem Blue Cross  
We must decide whether to pay for your drugs that are not on the preferred drug list, some brand-name drugs need review from us, or some drugs may have limits based on medical need. If your doctor thinks you need to take a drug that needs our review first, he or she will send us a request for this drug. Your doctor must include the medical information that supports the drug request. We will let your doctor know if we approve the request. If the request is denied, you will get a letter telling you why. 
If you plan to travel out of the state, you can get a vacation supply of your drugs. Ask the pharmacy to get an OK from us.  
 
Service from Anthem Blue Cross  
If you have a problem with our service, please call Member Services at 1-800-845-3604. If you have hearing or speech loss, you may call the TTY line at 1-888-757-6034
For your health and safety, we check the drugs you are taking. Some drugs can be harmful if taken together. If we have a concern about the drugs you are taking, we will let your doctor and pharmacist know. 
Important Toll-free Contact Numbers  
Anthem Blue Cross’ Prescription Drug Plan: 1-800-700-2533  
Anthem Blue Cross’ Prescription Drug Plan TTY: 1-800-905-9821 
Anthem Blue Cross Member Services: 1-800-845-3604 
Member Services TTY: 1-888-757-6034 
 

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Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.