Pharmacy Benefits

We work with Express Scripts (ESI) to provide your pharmacy benefits. We cover a wide range of prescriptions and many over-the-counter medicines.

Prescription Drug Benefits

Anthem Blue Cross and Blue Shield Medicaid covers most of the drugs your providers prescribe with no copay. In general, brand-name prescription drugs are covered only if there is no generic drug offered. Anthem Medicaid covers brand-name drugs in cases where the prescriber writes on the prescription that a brand-name drug is needed.

Over-the-counter (OTC) drugs are covered with a written prescription.

To view your drug benefit information, log on to Express Scripts.

Where Prescriptions Are Filled

A listing of the pharmacies in our network can be found in our provider directory. To make sure a pharmacy is part of our network or a drug is covered under your Anthem Blue Cross and Blue Shield Medicaid plan, please call 1-855-690-7784. The TTY number for members with hearing or speech loss is 711.

Retail pharmacies can dispense no more than a 30-day supply, but most prescriptions can be written with refills.

Don’t wait for an appointment – get these shots at the drugstore.

You used to have to go to your doctor’s office to get any of the shots below, but now you can get them at any pharmacy in your plan.

  • TDaP: tetanus, diphtheria, pertussis vaccine
  • Gardasil: human papillomavirus vaccine
  • Pneumovax 23 and Prevnar 13: pneumococcal pneumonia vaccines
  • Zostavax: shingles vaccine
Preferred Drug List and Formulary

The Anthem Blue Cross and Blue Shield Medicaid Preferred Drug List lists the brand name or generic name of a given drug. If a drug does not appear on this list, it must be approved before the prescription is filled to be covered. A prior authorization form must be completed by the prescriber and submitted to Anthem Medicaid before the prescription can be filled. You can email and ask us for an exception.

Preferred Drug List (PDL)

Search our PDL by drug name or disease category to learn more about the preferred drugs you can get through your pharmacy benefit. Always try drugs on the PDL first.

Searchable Formulary

Search through all the brand-name and generic drugs available through your pharmacy benefit on the formulary. You can search for your drug by:

  • Typing the name (at least first three letters) of the drug in the search box.
  • Using the A-Z list to search by the first letter of your drug.
  • Clicking on the therapeutic class of the drug.
Searchable formulary
Prior Approval

Getting prior approval encourages the proper use of medicines. Certain medicines on the Preferred Drug List may need prior approval. Use of medicines must meet FDA-approved indications and our medical necessity guidelines.

If a medicine requires prior approval, a prior authorization form must be filled out by the prescriber and submitted to Anthem Blue Cross and Blue Shield Medicaid.

Our pharmacy benefit has a mandatory generic program. It’s called the Multi-Source Brand Prior Authorization program. This program promotes the use of proper generic options as first-line therapies when medically appropriate.

Before prescribing any multi-source brand drug, prescribers are encouraged to consider using its preferred generic option. Brands with a generic option must have prior written approval and internal review by Anthem Blue Cross and Blue Shield Medicaid. This will decide if the drug is medically needed for it to be covered.

Quantity Supply Limits and Dose Optimization

Your pharmacy benefits allow up to a 30-day supply of medicine. This program defines a standard 30-day supply of medicine for a select list of drugs. If a medical condition warrants a greater supply than the defined 30-day supply, prior approval will help ensure access to the prescribed quantity.

Before dispensing a drug, a written request for approval must be submitted to Anthem Blue Cross and Blue Shield Medicaid to decide if the drug is medically needed.

Dose Optimization

The Dose Optimization Program helps patients follow drug therapies. This program is designed to work with you, your physician or health care provider, and the pharmacist to replace multiple doses of lower-strength medicines, where clinically suited, with a single dose of a higher-strength medicine (with approval from the prescribing physician).

Before dispensing multiple doses of the lower-strength medicine, a written request for approval must be submitted for review to Anthem Blue Cross and Blue Shield Medicaid. This review will decide if the medicine is medically needed.

ESI Reimbursement Form