Blue Shield has entered into an agreement with CVS Health to support manufacturer rebate and pharmacy network contracting for its outpatient pharmacy benefit and has received approval from the Department of Managed Health Care.
Anthem Blue Cross 2017 Individual and Family Plan Materials
For 2017, we have adjusted our product portfolio to include an exclusive provider organization (EPO) in most rating regions. Rating Regions 10 – 14 (Southern San Joaquin Valley counties) will continue to be offered PPO plans. Members on some 2016 PPO plans and all Tiered PPO plans in these areas will be transitioned to EPO plans effective 1/1/17 (unless they choose a different plan). Members will have access to our Pathway network of doctors and hospitals, but their EPO plan will not cover out-of-network benefits.
Specialty Drug Management Changes for Anthem Blue Cross Health Plans
Health care costs continue to rise, and specialty drugs are a big contributor. These prescription medicines are used to treat complicated and chronic conditions, such as hepatitis C, cancer and multiple sclerosis. As specialty drugs become more widely used, we’re looking for new ways to control costs while keeping members healthy. That’s why we created our Right Drug Right Channel (RDRC) program.
Determining Eligibility for both Medicare and Medi-Cal Extra Help
People who turn 65 and may have been receiving a hefty subsidy through Covered California to reduce their health insurance premium can be shocked at the costs of enrolling in Medicare. However, there are a variety of resources to assist Medicare beneficiaries to lower their health insurance and health care costs. Assistance from both Social Security and Medi-Cal may be an option for some Medicare beneficiaries depending on their household income.
Anthem Blue Cross moves to single drug list 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.
Anthem Blue Cross split fill drug program to reduce waste
Members will be allowed only 15 days per fill during the first 30 days, when starting on a select group of new specialty drugs. Copays are prorated during this time. The Split Fill program only applies to the first month of the drug fill at Accredo Specialty Pharmacy. After that, the prescription is filled as it is written by their doctor.
Feds urge drug makers and states to make Hepatitis C drugs available
Recognizing that we need both access and affordability, today we issued a notice to all 50 state Medicaid directors and sent letters to the CEOs of several drug manufacturers about providing access to therapy for Hepatitis C patients. Our notice to state Medicaid directors reminds states of their obligation to provide access to these promising therapies (consistent with section 1927 of the Social Security Act) based on the medical evidence, and that they have tools available to manage their costs. Our letter to manufacturers asks them to provide us with information on pricing arrangements and asks them for ideas to support the provision of these lifesaving medications to Medicaid programs at sustainable prices.
Anthem Blue Cross dropping coverage for certain prescription compounded drugs
Starting November 4, 2015, Anthem’s prescription drug plans will no longer pay for certain compound drugs that contain ingredients not approved by the Food and Drug Administration (FDA). A compound drug is a customized medication prepared by a pharmacist for a specific person. Some of your clients may be affected by this change, if they are taking one of these drugs, particularly ones containing:
OTC Nexium prompts drug formulary changes
Anthem Blue Cross of California August 4, 2015 NEXIUM® 24HR (esomeprazole 20 mg) became available as an over-the-counter (OTC) 14-day treatment for frequent heartburn in May 2014. As a result, our drug formulary (list of covered drugs) will change, effective October 1, 2015, as follows: Nexium 40 mg moves from Tier 2 to Tier 3 and has […]