Find out how you can save money and time on your medicines – and get them sent to your home!
If you are taking medicine on a regular basis, you have some choices that can save you time and money.
Formulary - The Formulary and/or tiered drug list includes FDA-approved drugs selected for their safety, effectiveness and value. A tiered drug list/formulary offers members many ways to save. Generic medications are typically included on Tier 1 and have the lowest copayment. Tier 2 and Tier 3 drugs cost slightly more.
Please click on the link below to view the Formulary listing. You may search the PDF Formulary document for specific drugs by keying CTRL + F on your computer. The drug listing begins on page 2.
Prior Authorization - Certain drugs you are taking may require prior authorization. Please click on the link below to view the Prior Authorization Drug listing. You may search the PDF document for specific drugs by keying CTRL + F on your computer.
Choice #1: Going to a pharmacy that's in our network will save you money.
If your pharmacy is in our network, your drug will be covered. If it's not in our network, you'll have to pay for the drug out of your own pocket.
Search a list of pharmacies in network by selecting Find a Doctor (Dentist, Pharmacy or Hospital) and selecting 'Pharmacy'.
Be sure to show your new member ID card to your pharmacy.
Remember to show your new member ID card to your pharmacy after January 1, 2015, so they'll have it on record. It will help make sure we pay your pharmacy claims the right way.
Choice #2: Using our home delivery pharmacy makes getting your medicine even easier.
Besides saving money, you can also save time, if you use our home delivery pharmacy, managed by Express Scripts. Through our home delivery pharmacy, you get:
- Your medicine brought to your home within two weeks.
- Your prescription checked by registered pharmacists.
- Your questions answered 24 hours a day, seven days a week by a pharmacist.
- Free standard shipping, automatic refills if you want them and a choice of ways to pay.
- Up to a 90-day supply for most drugs, so it's fewer refills with no trips to the pharmacy. Many 90-day supplies cost the same as two 30-day ones at a local pharmacy, so you might save money, too!
How to get started with our home delivery pharmacy.
- You don't have to sign up for home delivery, but if you want to take advantage of this added benefit you have a few options:
- Phone: Call 866-297-1013, 24 hours a day, seven days a week. Ask to sign up for the home delivery pharmacy.
- Website: Log in and select Switch to Home Delivery from the Pharmacy page. Follow the instructions.
- Fax: Have your doctor fax your prescription(s) to 866-272-8856. It must be faxed directly from your doctor's office.
- Mail: Follow the website instructions above and choose Print a Prescription Order Form. Print the form, fill it out and mail the form (with your prescription and payment) to:
Home Delivery Pharmacy
P.O. Box 66558
St. Louis, MO 63166-6558
Certain drugs you are taking may also require prior authorization. That means the drug needs to be approved before it's covered by your plan. In order to make this decision, we need a little more information from your doctor or pharmacist. Please click here for a list of drugs that require prior authorization.
What should you do next?
It's ok to ask your doctor or pharmacist to call or fax us the information we need to approve the drug you need. The pharmacist might also have a message on their computer that tells them the drug needs to be approved before it can be filled. Once we have the information we need from the doctor or pharmacist, your prescription can be approved and filled.
If the request to cover your drug is denied, please talk to your doctor or pharmacist about other drugs that may be right for you. You'll also receive a letter in the mail that explains how to appeal the denial.
Why do some drugs need approval?
Certain drugs need to be reviewed by your plan to make sure they're being used safely and efficiently. This review focuses on drugs that may have:
- Risk of side effects
- Risk of harmful effects when taken with other drugs
- Potential for incorrect use or abuse
- Better options that may cost you less or work better
- Rules for use with certain health conditions
Your prescription drug benefit includes coverage for medicines that you'll find on the Anthem National Drug List. You can find more savings that is describes medicine that is on our formulary drug list of commonly asked questions and answers about how the drug list works with your prescription drug plan. Click here to review our formulary drug list.