How Can I Find Out if My Prescription Drugs Are Covered by My Anthem Medicare Plan?

Last Updated : 09/09/20183 min read

If you’re a Medicare beneficiary, there are a couple of ways you can get coverage for your prescription medications – through a Medicare Advantage Prescription Drug plan, or a stand-alone Medicare Part D Prescription Drug Plan. Anthem is a private insurance company approved by Medicare to provide Medicare prescription drug coverage.

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If you’re enrolled in an Anthem Medicare Advantage plan with prescription drug coverage, here are steps you can take to find out if your medications are covered under your Anthem Medicare plan.

What is an Anthem Medicare prescription drug formulary?

A formulary is a list of drugs that a prescription drug plan covers. It’s generally organized into tiers, or pricing levels. Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans develop their own formularies. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.

Federal regulations require all Medicare prescription drug plans to provide minimum standard benefits, and many Anthem Medicare Prescription Drug Plans offer expanded coverage.

Anthem Medicare Advantage plans with prescription drug coverage and stand-alone Anthem Medicare Part D Prescription Drug plans may use one or more of the following cost-control measures in their formularies:

  • Tiered formulary. There are usually three to six different tiers, with the lower tiers having smaller copayments and coinsurance requirements (in some cases with no deductible), while medications in the higher tiers have higher out-of-pocket costs.
  • Prior authorization. In some cases, your health-care provider must contact your plan and demonstrate medical necessity for your medication before the plan will authorize payment.
  • Step therapy. Occasionally, several different drugs may be effective for the same condition. Your Anthem Medicare plan may request that your doctor start you on the lowest-priced effective medication and check your response to therapy before approving a more expensive medication.
  • Quantity limits. Your plan may limit the number of pills, tablets, or doses to treat your condition, or restrict the number you can purchase or refill in a particular period of time.

If your health-care provider believes that you need a medication not included on your Anthem Medicare prescription drug plan’s formulary, you have the right to request an exception.

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How can I find out if my medications are included in my Anthem Medicare formulary?

You can register for an online account on the Anthem Medicare website to check your prescription drug coverage and manage your benefits, as well as pay bills, monitor claims, and track expenses.

You can also use Anthem Medicare’s online prescription drug search tool to see if your medication is covered by your plan. To view a list of plan formularies available online, go here.

If you aren’t able to find the information you need online, visit the Anthem Customer Support page to find telephone numbers and contact information for your Anthem Medicare plan.

Click the Find Plans button on this page to compare your Medicare options.

Anthem Blue Cross and Blue Shield serves Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin.

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