AIM EPO – Pharmacy Benefits
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. A generic drug is the same drug without a brand. Generic drugs are approved by the Food and Drug Administration (FDA) and they are a safe, equally effective alternative to brand-name drugs. Generic drugs require the same testing as brand-name drugs, and are no different when it comes to strength, dosage, form, route of administration or intended usage. You can usually buy 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.
Your provider may suggest you get an over-the-counter drug. If you get a written prescription from your provider, some over-the-counter drugs will be covered. Take the prescription to the pharmacy to get it filled.
Where to Get Your Prescriptions Filled
You can fill your prescriptions at more than 4,400 retail pharmacies in California. In our Provider Directory, you will find a list of pharmacies near you that work with Anthem Blue Cross. You must go to one of these pharmacies for your prescription drugs. If you want to check if a certain pharmacy works with Anthem Blue Cross or if a drug is covered, call 1-866-297-1013. The TTY number for members with hearing or speech loss is 1-800-905-9821.
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 using home delivery of your medications, you will receive a 90-day supply. If you have questions or need a home delivery order form, you must visit the Express Scripts website after login to your health plan site. Click the link in the Refill a Prescription section after login. On the Express Scripts website, select the Blank Prescription Order Form from the Printable Forms section. You can also call 1-866-297-1013.
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. Preferred Drug List.
| No copayment per prescription for up to a 30-day supply for brand-name or generic drugs, including smoking cessation drugs, from an in-network retail pharmacy|
No copayment per 90-day supply of maintenance drugs supplied through home delivery
| Maintenance drugs are drugs that are prescribed for 60 days or longer and are usually prescribed for chronic conditions such as arthritis, heart disease, diabetes or hypertension|
| No copayment for prescription drugs provided in an inpatient setting|
| No copayment for drugs administered in the doctor’s office or in an outpatient facility setting during the member’s stay at the facility|
| No copayment for FDA-approved contraceptive drugs or devices|
Some Drugs Need an OK from Anthem Blue Cross
We must OK payment for drugs that are not on the preferred drug list. Some brand-name drugs need an OK from us. Some drugs may have limits based on medical need. If your doctor thinks you need to take a drug that needs an OK, he or she will send us a request for this drug. Your doctor must include the medical records that support the drug request. We will let your doctor know if we approve the request. If the request for payment 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 Customer Service at 1-877-687-0549. 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
Home Delivery: 1-866-297-1013
WellPoint NextRx TTY line: 1-800-905-9821
Anthem Blue Cross Customer Service: 1-877-687-0549
Customer Service TTY line: 1-888-757-6034