Pharmacy Benefits

Get Your Medicine

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

Fill your prescription drugs

You can bring your Anthem Blue Cross Cal MediConnect Plan card and your prescription to a network pharmacy or a mail-order pharmacy. You can also order and manage your prescriptions online by logging into your account.

As a Medicare member, you may qualify for Extra Help with your Medicare prescription drug costs. To qualify for Extra Help, you must be receiving Medicare, have limited income, and live in one of the 50 states. Please visit the Social Security website for further information.

See what drugs we cover

• Notice of Formulary Changes
• List of Covered Drugs (Formulary) - English
• List of Covered Drugs (Formulary) - Chinese
• List of Covered Drugs (Formulary) - Spanish
• List of Covered Drugs (Formulary) - Tagalog
• List of Covered Drugs (Formulary) - Vietnamese

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

Call Pharmacy Member Services toll free at 1-833-370-7466 (TTY: 711) 24 hours a day, 7 days a week to ask us to mail you a Drug List. 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 Drug List. When you email us, we’ll call you to verify your membership so we send you the right Drug List.

Don’t see your medication on the Drug List?

You may be able to receive a temporary supply of your current medication. Read about our transition plan here.

Find a pharmacy in our network

Don’t see your pharmacy?

Download a copy of the Provider and Pharmacy Directory.

Mail-order pharmacy

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

We make getting your prescriptions filled as convenient as possible. You can log in to your account and manage your prescriptions filled through home delivery. With your secure online account, you can:

• Order refills
• Track your shipments
• Get notifications

You can also call IngenioRx Home Delivery at 1-833-203-1738 (TTY: 711) or Pharmacy Member Services at 1-833-370-7466 (TTY: 711) 24 hours a day, 7 days a week to get order forms and information about filling your prescriptions by mail and/or sign up for automated mail-order delivery. Download the IngenioRx Mail Service Order Form here .

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 IngenioRx Home Delivery at 1-833-203-1738 (TTY: 711) or Pharmacy Member Services at 1-833-370-7466 (TTY: 711) 24 hours a day, 7 days a week. The call is free.

*IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of your health plan.

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.