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Pharmacy Benefits

Your benefits include a wide range of prescriptions and over-the-counter (OTC) medicines. We work with CarelonRx 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.

Click here to see the list of medications available for a 90-day supply, and all other drugs are limited to a 34-day supply. Most prescriptions can be written with refills.

Have your medicines mailed to you

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

  • Order refills.
  • Track your shipments.
  • Receive notifications.
Log into your account

Medications straight to your doorstep

With the ZipDrug pharmacy program, you’ll get customized care at no extra cost. ZipDrug will connect you with a participating local pharmacy. The pharmacy will package your medications by time and day to help you understand what to take and when. They’ll also schedule free hand-delivery. You may even qualify for one-on-one support from the local pharmacy. They’ll create a personalized care plan to help manage your medications and health conditions.

Here’s how it works:

  1. Call to enroll at 844-947-3784 Monday through Friday, 9 a.m. to 5:30 p.m. Eastern time> 
  2. Your prescriptions will be transferred by your participating local pharmacy. They’ll package your medications by time and day and set up refills so they’re on the same schedule. 
  3. Receive your prescriptions by scheduled hand-delivery, at no extra cost. When your prescriptions are ready, the pharmacy will call you to schedule delivery for a day and time that’s most convenient. 

Your costs

There is no pharmacy copay for Cardinal Care and FAMIS members. 

Drug Coverage Information

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

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 to Z list to search by the first letter of your drug.
  • Clicking on the therapeutic class of the drug.
Search the formulary

2022 Formulary for Open Enrollment

This is a list of drugs we will cover in 2023, 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 or by calling Pharmacy Member Services at 833-207-3120. 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. You can 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

Click here to see the list of medications available for 90-day supply. All other drugs are limited to a 34-day supply. If you need more medicine than the standard 34-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 the Anthem HealthKeepers Plus plan 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 34-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. The Anthem HealthKeepers Plus plan 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 the Anthem HealthKeepers Plus plan to review your case and replace your medicines as needed.

If you have any questions about your pharmacy benefits, call Pharmacy Member Services at 1-833-207-3120 (TTY 711) 24 hours a day, seven days a week.

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.

CarelonRx 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 CarelonRx Specialty Pharmacy and AcariaHealth to meet all your specialty medication needs.

Learn about specialty pharmacy