We cover a variety of safe and effective prescription and over-the-counter drugs.
The medicines you need. Little to no cost to you.
Preferred Drug Lists
Doctors use the Preferred Drug List (PDL) to prescribe your medicines. We review medical studies and the drugs on our PDL to help make sure you’re getting drug therapy that’s safe and helpful for your care. You may need to get prior approval from us for some drugs.
How to use our PDL
Our PDL lists the brand name and the generic name for each preferred drug. Search your plan’s PDL by drug name or disease category to learn about the prescription medicines your plan pays for. We recommend you try the drugs on the PDL first because they’re known to be safe and effective options.
2019 Formulary for Open Enrollment
The formulary lists all the drugs your plan covers, including preferred and non-preferred drugs. Search for brand-name and generic drugs on the formulary for your plan. 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 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.
What you get with HealthKeepers, Inc.
You can get prescription drugs you need at no or low cost as part of your benefits. In most cases, brand-name prescription drugs are covered only if there isn’t a generic drug available. We’ll also cover brand-name drugs if the brand-name version is medically necessary and you get prior approval.
You can fill your prescriptions at more than 5,000 retail pharmacies in your plan across Virginia.
Find pharmacies near you in our provider directory or using our Provider Finder
To make sure your pharmacy is in your Anthem HealthKeepers Plus plan, call 1-800-901-0020 (Medallion Medicaid, FAMIS) or 1-855-323-4687 (CCC Plus); TTY 711.
Retail pharmacies can only give you up to a 30-day supply, but most prescriptions can be written with refills. If you’re a FAMIS member, you can get mail-order services.
If you can’t find a drug listed on our PDL, you’ll need to get prior approval from us to get that drug covered under your pharmacy benefit. We’ll review the medicines to make sure they’re medically necessary and meet FDA standards.
You may also need prior approval from us to get:
- Select drugs listed on our PDL.
- A higher supply 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.
Your prescriber needs to fill out a prior approval form and submit it to us before you can fill your prescription.
Call Member Services at 1-800-901-0020 or 1-855-323-4687 if you’re an Anthem CCC Plus member; TTY 711 to get a prior approval form or learn more about prior approvals.
If the drug you’re looking for isn’t on our drug list, you can email and ask us for an exception at email@example.com.
Your pharmacy benefits allow up to a 30-day supply of medicine. If you need more medicine than the standard 30-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, 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.
Medallion Medicaid and CCC Plus members – There’s no copay for up to a 30-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:
- Retail up to 34-day supply: $2 per prescription
- Retail 35- to 90-day supply: $4 per prescription
- Mail service up to 90-day supply: $4 per prescription
- Retail up to 34-day supply: $5 per prescription
- Retail 35- to 90-day supply: $10 per prescription
- Mail service up to 90-day supply: $10 per prescription
There is no copay for FDA-approved contraceptive drugs or devices.
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.
- 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.
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.
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.Drug list/formulary selection process
Guidelines for re-evaluation submissions
Find more information on the drug or drug class updates in the drug list/formulary updates
Visit the Centers for Medicare & Medicaid Services’ website for the latest news on the e-Rx Incentive Program
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