Anthem Blue Cross of California
Anthem’s Rx Select Drug List for 2016- What it means for Small Groups
In 2016 Anthem released a single enhanced Rx Select Drug List for the Small Group portfolio. This was a change from the prior year’s plan offering of both Select & National Formulary Drug Lists. You may be wondering how this change impacts small groups and important details about this new formulary.
Why did we choose to offer a single Select Drug List?
In past years, understanding the differences between a National & Select Formulary Drug List caused confusion and abrasion in the marketplace. Anthem’s intention was to create a single Drug List that would meet our member’s needs with the least amount of disruption, and include a comprehensive list of drugs in every class & category that maintained affordability within our portfolio.
- Meets ACA guidelines
- Achieves a cost savings of 5-6% off medical premiums across all plans
- Limits disruption to members – less than 5% of members will be impacted by the change to the Select Drug List
What does the Select Drug List include?
- The top 25 most used drugs based on claim volume are all covered under Tier 1 of the new Select Drug List*
- The majority of commonly used drugs on the National Rx Formulary are on the new Select Rx Formulary
- The Select Drug List includes lower-cost generic options
To find out more, please review the following links:
2016 Select Drug Marketing Flier
What if a member’s medication is not on the Select Drug List?
Members should review the Select Drug List to see if their medications will continue to be covered. Chances are they will – the top 15 drugs from the National Drug List that are not covered on the Select Drug List all have covered alternative options.*
And if the member’s doctor determines that an alternative covered option is not appropriate for the treatment, the doctor can request an exception review.
As Anthem strives to refine our portfolio; including maintaining our price and product competitiveness for the Small Group market, we will continue to evaluate our Select Drug List that balances our members’ needs with a comprehensive offering.
*based on Anthem’s internal data, 2015
This article applies to:
- California
- Small Group