Anthem Blue Cross : Pharmacy information for AIM HMO members

Pharmacy information for AIM HMO members

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AIM 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. 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 Anthem Blue Cross’ prescription drug plan toll-free at 1-800-700-2533. 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 through home delivery, you will receive a 90-day supply. If you have questions or need an order form to use home delivery, call Anthem Blue Cross’ prescription drug plan at  1-800-700-2533. Or, obtain a form by visiting the Express Scripts website after login to your health plan site. Click the Refill a Prescription link after login. 
Preferred Drug List 
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.  
Our printable drug lists are located in the Forms Library on your health plan website 
If you would like to know if a drug is on the preferred drug list, you can view it by: 

Visiting anthem.com/ca

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

Selecting Download Forms on the resulting page to visit the Forms Library

 
Cost to Member 
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 decide whether we’ll pay for drugs that are not on the preferred drug list, we may need to check some brand-name drugs you need, or some drugs may have limits based on medical need. If your doctor thinks you need to take a drug that we must review first, 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 your 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 
Prescription Drug Plan: 1-800-700-2533 
Prescription Drug Plan TTY line: 1-800-905-9821 
Anthem Blue Cross Customer Service:  1-877-687-0549 
Customer Service TTY line: 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.