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Pharmacy Benefits

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

Your benefits include a wide range of prescriptions and over-the-counter (OTC) medicines. We work with IngenioRx to provide these pharmacy benefits.

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Prescription drugs
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OTC drugs with a written prescription

Find a pharmacy

To find a pharmacy near you, use our pharmacy locator tool.

Find a pharmacy

Fill a prescription

Bring your member ID card and prescription to a plan pharmacy. A doctor can also call in the prescription for you.

It’s good to use the same pharmacy each time you fill a prescription. This way, your pharmacist will know about problems that may happen when you’re taking more than one prescription. If you use another pharmacy, you should tell the pharmacist about all medicines you are taking.

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

Your costs

Copays are a set dollar amount you pay for a covered service, like getting a prescription filled.

Generic drugs: $1 per script
Brand-name drug that does not have a generic: $1 per script
Brand-name drug that has a generic version available: $4 per script

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.

Drug coverage information

Your benefits include a wide range of prescription drugs. Anthem Medicaid also covers many over-the-counter (OTC) medicines with a prescription from your doctor. We have two drug lists that show which drugs are in your plan.

Preferred Drug List (PDL)

The Preferred Drug List (PDL) is the list of drugs that your doctor will use first when prescribing you medicine. These drugs have been chosen for their quality and effectiveness. Your doctor can prescribe most of these medicines to you without getting preapproval, or an “OK,” from us. The PDL is updated frequently.

Searchable formulary

The formulary is a list of all brand-name and generic drugs available in your plan. It lists all the drugs found on the PDL, plus others. All drugs on the formulary are covered, but many require preapproval before the prescription can be filled.

Find your medicine

Do you want to look up your medicine and find out if it is covered in your plan? It’s easy when you use our search tool. This tool will help you learn about any limitations or restrictions for any particular drug.

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.
Search the formulary
Don’t see it listed?

If you don’t see your medicine listed on the drug lists, you may ask for an exception at submitmyexceptionreq@anthem.com. You’ll be asked to supply a reason why it should be covered, such as an allergic reaction to a drug, etc.

Prior authorizations (preapprovals)

Some medicines need a preapproval, or an “OK,” from Anthem Medicaid before your provider can prescribe them. The preapproval process helps us make sure that you’re taking medications safely and correctly.

Here are some reasons that preapproval may be needed:

  • There is a generic or pharmacy alternative drug available.
  • It is for a greater quantity of medicine than our standard 30-day supply.
  • The drug could be misused or abused.
  • There are other drugs that should be tried first.
  • The drug has a high side effect potential.
  • The drug is prescribed at a higher dosage than recommended.
  • There is additional information needed about your condition so we can match it to the FDA approval of the drug and/or studies of effectiveness.

For medicines that need preapproval, your provider will need to call 1-855-661-2028. Anthem Medicaid will review the request and give a decision within 24 hours. If you need your medicine right away, you may be able to get a 72-hour supply while you wait.

Need help?

If you misplace your medicine or it is stolen, contact your provider. They will work with the pharmacy and Anthem Medicaid to review your case and replace the medicines as needed.

If you have any questions about your pharmacy benefit, call Pharmacy Member Services 24 hours a day, 7 days a week at 1-833-207-3113 (TTY 711).

Prescription Drug Reimbursement Form

If you had to pay for a medicine that is covered under your plan, you may submit a request for reimbursement form.

For medicines purchased before October 1, 2019:

For medicines purchased on or after October 1, 2019:

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Get your specialty medications

If you have a complex or chronic health condition that requires special medicine, we can help. We partner with IngenioRx Specialty Pharmacy and other pharmacies to meet all your specialty medication needs.

Learn about specialty pharmacy