Blue Cross Rx Prescription Coverage & Information

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Anthem Launches IngenioRx, New Pharmacy Benefits Manager   PBM

Anthem is establishing a new pharmacy benefits manager to be named IngenioRx.      IngenioRx will begin offering a full suite of PBM solutions starting in 2020, which coincides with the conclusion of the company’s current PBM contract.   FAQ’s

 

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6 comments on “Rx Prescription Information

    • You can find your plan summary using this tool
      https://plan-summaries.anthem.com/sobdps/

      Your PPO plan uses the select drug list.

      Here is where Blue Cross shows all their various Rx lists
      https://www11.anthem.com/ca/pharmacyinformation/

      Small Group Select Drug List (Searchable) | (PDF)

      WOW, it’s not on the formulary!!!

      If my medicine isn’t on the drug list, what are my options?
      Here are a few things to think about:

      o If you want to take a drug that’s not on the drug list, you may have to pay the full cost for it.
      o You can also talk to your doctor or pharmacist to see if there’s another drug covered by your plan that will work just as well, or if generic or OTC drugs are an option. Only you and your doctor can decide what drugs are right for you.
      o You can search for generic drugs at anthem.com/ca. OTC drugs aren’t shown on the list.
      o If a drug you’re taking isn’t covered, your doctor can ask us to review the coverage. This process is called preapproval or prior authorization. Your doctor can get the process started by calling the Member Services number on the back of your member ID card or by downloading a prior authorization form from our website and submitting it.

      https://www.covermymeds.com/main/partners/anthem/
      CoverMyMeds is Anthem’s Preferred Method for Receiving ePA Requests

      If your request is approved, the amount you pay for the drug will depend on your plan’s benefit

      flomax not on formulary

      select drug list

    • APPROVAL CRITERIA

      I. The individual must meet one of the following criteria to receive a non-formulary medication for formulary co-pay;
      A. Individual has previously tried and failed 2 (two) formulary products (when available):
      One of which has to be in the same specific drug class; the other product can be in a
      different drug class however it must have the same indication as the product requested.
      OR
      B. For combination products: Individual must try two formulary products:
      One of which must be in the same specific class as at least one ingredient in non-formulary combination product.
      OR
      C. For Non-Formulary antibiotics/ anti-virals/ anti-fungals, individual has previously tried and
      failed one formulary antibiotic/ anti-viral/ anti-fungal product within the same route of
      administration
      OR
      D. The individual has a documented drug interaction
      OR
      E. The individual has documented adverse drug experiences (side effects, adverse drug
      reaction)
      II. Any request for a Non-Formulary prescription medication that does not meet criteria in section I shall be subject to the normal medical necessity review. Source

    • Alternatives to Flomax???
      https://www.medicalnewstoday.com/articles/319932.php

      Flomax, the branded version of the drug tamsulosin, is often prescribed to relieve the symptoms of BPH. benign prostatic hyperplasia

      Flomax can cost more than $200 per month and might not be entirely covered by insurance. Flomax may be no more effective than other alpha-blockers, but the manufacturing company spends more than $100 million marketing it to consumers, so it is often the only BPH drug many people know about.

      A generic form of Flomax, called doxazosin, may cost as little as $10 per month.

      doxazosin flomax generic

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