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Pharmacy Benefits

Get Your Medicine

Anthem Blue Cross Cal MediConnect works with many pharmacies in Santa Clara County. And we cover a wide range of brand-name and generic drugs.

pair in storeroom

Fill your prescription drugs

Bring your Anthem Blue Cross Cal MediConnect card and your prescription to a network pharmacy. You can also use a network mail-order pharmacy.

See what drugs we cover

2019 Formulary List - Updated as of 08/01/2019

Do you need a printed copy of the Formulary (Drug List)?

Call Member Services at 1-855-817-5785 (TTY 711) Monday through Friday from 8 a.m. to 8 p.m. Pacific time to ask us to mail you a formulary. You can order by phone whether or not you’re already a member.

If you’re already a member, you can email us at DirectoryRequest_MMP@anthem.com to ask for a printed formulary. When you email us, we’ll call you to verify your membership so we send you the right formulary.

Don’t see your medication on the Drug List?

You may be able to keep taking the medicine you take now for a while. Read about our transition plan here.

Find a pharmacy in our network

Mail-order pharmacy

As an Anthem Blue Cross Cal MediConnect Plan member, you can get prescription drugs shipped directly to your home through Express Scripts, Inc., our network mail-order pharmacy program.

To get order forms and information about filling your prescriptions by mail, call Express Scripts Mail Order department at 1-866-830-3883 (TTY 711) 24 hours a day, 7 days a week or visit Express Scripts Website.

You can expect to receive your drugs within 14 days after you place your order. If your mail-order drugs do not arrive within 14 days, you should call Member Services at 1-855-817-5785 (TTY 711).

As a member, you may be able to sign up for automated mail-order delivery of all new prescriptions at any time by calling 1-866-830-3883 (TTY 711) 24 hours a day, 7 days a week or going to www.express-scripts.com.

Grievances and Appeals

What is a grievance?

A grievance is a type of complaint that does not involve the denial of payment, or denial or discontinuation of services by our health plan or our network providers.

You might file a grievance if you have a problem with things such as:

  • You feel you are being encouraged to leave your plan
  • Waiting times on the phone, at a network pharmacy, in the waiting room, or in the exam room
  • The way your doctors, network pharmacists or others behave
  • Not being able to reach someone by phone or get information you need
  • A problem with customer service

When can a grievance be filed?

You can make a grievance complaint at any time unless it is about a Part D drug. If the complaint is about a Part D drug, you must file it within 60 calendar days after you had the problem you want to complain about.

What is an appeal?

An appeal is when you ask us to review a decision we made about coverage of a Part D prescription drug or the amount you must pay for the coverage.

You might file an appeal if:

  • We refuse to cover or pay for a Part D prescription drug you think we should cover
  • We turn down your request for an exception to cover a prescription drug
  • You disagree with the amount you must pay for cost-sharing for a Part D prescription drug

When can an appeal be filed?

You may file an appeal within 60 calendar days of the date on the letter we sent to tell you of our decision. You might be able to file an appeal even if 60 days have passed since we made our first decision. Tell us in your written request why you could not file within the 60 days allowed.

To get more information, read more about how to file a grievance or how to file an appeal.

 
 

Quality Assurance and Utilization Management

Initiatives designed to improve quality, prevent over- and under-utilization and reduce costs.

Learn More

H6229_19_109255_U CMS Accepted 06/28/2019 Page Last Updated on 08/16/2019