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Pharmacy Benefits

Prescription and over-the-counter (OTC) drug benefits

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Prescription drugs

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OTC drugs with a written prescription

Learn more about your prescription drug benefits on your  ExpressScripts account

Searchable formulary

The formulary lists all the covered drugs in your plan, including preferred and nonpreferred drugs.

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.

Some drugs on the formulary may have special requirements for you to get them. After you search for a drug on the formulary, check the key to see what any icons mean.

Searchable formulary

If you need a drug that isn’t listed on our formulary, you or someone you choose to act for you can request a formulary exception. Just email submitmyexceptionreq@anthem.com.

Preferred Drug List

Look in our Preferred Drug List (PDL) to find the generic and brand-name versions of the preferred drugs your plan pays for. We recommend you try the drugs on the PDL first because they’re known to be safe and effective options.

If you can’t find a drug on this list, your doctor needs to ask us for prior approval before you can get it. You may still need to get prior approval for some drugs on the PDL. Be sure to check the key to see what any icons mean. 

Preferred Drug List - English
Preferred Drug List - Spanish

Where to get your medicines

You can get your prescriptions filled at any of the drugstores in our plan. Use our  Provider Finder tool to search for drugstores near you or look in the provider directory.

You can also get other services at our plan pharmacies. Don’t wait for an appointment — get these shots at the drugstore:

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

Prior approval

Prior approval requirements help make sure you’re using medicines safely. We’ll review the medicines to make sure they’re FDA-approved and medically necessary for your health.

If you need to get prior approval for a medicine, your prescriber needs to fill out a prior approval form and submit it to us.

You’ll need to get prior approval for:

  • A greater quantity of medicine than our standard 30-day supply.
  • Multiple doses of medicines.
  • Brand-name drugs if there is a generic that’s appropriate for your care.

Dose optimization

The Dose Optimization program can help you follow your medicine routine. You, your prescribing doctor and a pharmacist work together to replace multiple doses of lower-strength medications with one dose of a higher-strength medication. Your prescribing doctor has to approve this change to make sure it’s appropriate for your care.

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