Anthem Generic Premium Formulary
Anthem Generic Premium Formulary
Anthem Generic Premium Formulary
Anthem Generic
Premium Formulary
For Individual and Employer Groups
Revised 01/04/10
GPM_0110 Rev. 01_10
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Anthem Blue Cross and Blue Shield prescription drug benefits include medications available
• If you have additional on the Anthem Generic Premium Formulary. Our prescription drug benefits can offer
questions about your
potential savings when your physician prescribes medications on the Anthem Generic
prescription benefits
please call the Member Premium formulary.
Services number on your
ID card
• Speech and hearing QUESTIONS AND ANSWERS
impaired (TDD/TTY users)
Q. What is the Anthem Generic Premium formulary and how is it different from the
should call 800-221-6915,
Monday – Friday, 8:30 Anthem Drug List/Formulary?
a.m. – 5:00 p.m., ET A. The Anthem Generic Premium formulary is a generic-based drug list that includes select
brand-name alternatives in many therapeutic classes. It is different from the Anthem Drug
• For the most current
version of this List/Formulary which provides a more comprehensive list of FDA-approved brand-name and
prescription drug list, generic medications.
please visit anthem.com
The medications on the Generic Premium formulary are subject to periodic review. Please
• Bring a copy of this drug visit bcbsga.com or call Member Services to request the latest version of the Generic
list to your next doctor’s
visit to assist in selecting Premium formulary list.
the lowest cost Brand-name: A brand-name drug is usually available from only one manufacturer and
medications may have patent protection.
Generic: A generic drug is required by the FDA to have the same active ingredients as
its brand-name counterpart, but is normally only available after the patent protection
expires on a brand-name drug. Although it may look different, a generic drug works
the same as its brand-name counterpart. You can save money by using generic
medications.
Q. What are ‘clinically equivalent’ medications? How does this affect my drug coverage?
A. The most current research available is used to determine if multiple drugs used to treat a
disease/condition produce the same clinical effect. When this is the case, we may
recommend covering only the lower cost drug(s) as part of our effort to help reduce the
overall cost of care. This means your specific prescription plan may not cover some drugs.
In addition, select drugs will require prior authorization of benefits review. Medication utilization
must meet FDA-approved indications as well as plan guidelines.
Please note: This list is subject to change without notice. The inclusion of a medication on the list
is not a guarantee of availability or benefits. For verification of a medication, please contact your
pharmacy benefits manager.
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TIER 1 AND TIER 2 ALTERNATIVES FOR COMMON THERAPEUTIC CATEGORIES
Please note: Some of the drugs in this table may be used to treat other conditions. Possible alternatives listed in this table may be from different drug
classes and may not be considered equivalent. Only your doctor can determine if a drug is right for you. The drugs listed in this table do not represent
all the therapeutic options for the condition listed.
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For Kentucky Residents Only:
In selecting medications for the Generic Premium formulary, the therapeutic efficacy and cost effectiveness are addressed for each category. All
therapeutic categories are represented on the Generic Premium formulary by at least one medication. When a closed formulary is in effect, only
medications that are included on formulary are covered. In certain clinical situations, a member may require use of a noncovered drugs. Anthem has
criteria that permits a member to obtain a non-covered drug in a closed formulary plan. If specific criteria are met, a member can receive a non-covered
drug for the same out of pocket amount that would be required by a covered drug in the same class. The criteria preserves the clinical integrity of the
Generic Premium formulary and provides a process by which deviations from the formulary may be allowed. An appeals process is in place for any
medications that do not meet the criteria.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health
Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In
Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and
HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT
and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical
Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia (excluding the city of
Fairfax, the town of Vienna and the area east of State Route 123): Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin
(“BCBSWi”), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which
underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies.Independent licensees
of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield
names and symbols are registered marks of the Blue Cross and Blue Shield Association.
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