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Pharmacy Benefits

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

Find a pharmacy

You can fill your prescriptions at more than 5,000 retail pharmacies in your plan across Virginia. 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.

Retail pharmacies can only give you up to a 31-day supply, but most prescriptions can be written with refills.

Your costs

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

Medallion Medicaid and CCC Plus members — There’s no copay for up to a 31-day supply for brand-name or generic drugs, including smoking cessation drugs, as long as you go to a pharmacy in your plan.

FAMIS members may have a copay for some medicines:
Low copays

  • Retail up to 34-day supply: $2 per prescription
  • Retail 35- to 90-day supply: $4 per prescription

High copays

  • Retail up to 34-day supply: $5 per prescription
  • Retail 35- to 90-day supply: $10 per prescription

There is no copay for FDA-approved contraceptive drugs or devices.

Drug coverage information

Your benefits include a wide range of prescription drugs. Anthem HealthKeepers Plus 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

2020 Formulary for Open Enrollment

This is a list of drugs we will cover in 2020, including preferred and non-preferred drugs.

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.

Helpful information

Our Medication Synchronization program (Med Sync) makes getting all your medicines easier — at no extra cost to you. Med Sync helps get your refills on the same schedule so you can pick up most of your medicines on just one day each month.

Our Med Sync program can help you:

  • Cut down on trips to the pharmacy.
  • Make sure you have your medicines when you need them.
  • Work with your pharmacist so you can stick to a medicine routine.

Get started with Med Sync today! Talk to your pharmacist about coordinating your prescriptions to get started.

Have more questions about Med Sync? Call 1-800-901-0020 (TTY 711).

These kinds of medicines aren’t paid for by your plan:

  • Infertility medications
  • Cosmetic and hair-growth medications
  • Dietary supplements, except for treatment of phenylketonuria (PKU)
  • Erectile dysfunction medications
  • Drugs not approved by the FDA

Your pharmacy benefits allow up to a 31-day supply of medicine. If you need more medicine than the standard 31-day supply to treat a condition, you can ask us for prior authorization. We’ll make sure you can get the quantity of medicines you need.

Dose optimization

Dose optimization, or dose consolidation, helps you stick with 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.

What is e-Prescribing?

Electronic prescribing, or e-Prescribing, lets the doctor who prescribes your medicines send your information right to a retail or mail-order drugstore in your plan.

Why e-Prescribing?

  • Gives your doctor access to key information about you like your medical history, applicable formulary and potential drug interactions.
  • Checks your prescriptions for dosage, drug interactions and duplication at the time of prescribing.
  • Saves you time by speeding up the medicine refill process.
Visit the Centers for Medicare & Medicaid Services’ website for the latest news on the e-Rx Incentive Program

The Pharmacy and Therapeutics (P&T) Committee picks drugs considered to be the top choices based on their safety, effectiveness and value for our Drug List/Formulary.

The P&T Committee is an independent group that includes practicing doctors, pharmacists and other health care professionals responsible for the research and decisions surrounding our Drug List/Formulary. This group meets regularly to review new and existing drugs, and to choose the top medications for our Drug List/Formulary.

The P&T Committee also helps improve customer health through programs like drug utilization review, promoting medication safety and encouraging compliance.

Learn more about our P&T Committee

Outcomes-based formulary

We offer an outcomes-based formulary. That means we use a balanced approach to drug list/formulary management, based on a combination of research, clinical guidelines and member experience. The latest developments and submission guidelines from around the world are considered when developing and maintaining the drug list/formulary.

Prior authorizations (preapprovals)

Some medicines need a preapproval, or an “OK,” from Anthem HealthKeepers Plus 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 higher supply of medicine than our standard 31-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 Provider Services. Anthem HealthKeepers Plus 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 HealthKeepers Plus to review your case and replace your medicines as needed.

If you have any questions about your pharmacy benefit, call Pharmacy Member Services at 1-833-207-3120 (TTY 711) 24 hours a day, seven days a week. CCC Plus members, call 1-833-235-2027 (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:

IngenioRx Notice of Privacy Practices

Get your specialty medications

If you have a complex or chronic health condition that requires special medicine, you can get the medicine you need. We partner with IngenioRx Specialty Pharmacy and AcariaHealth to meet all your specialty medication needs.

Learn about specialty pharmacy