With the exit of Anthem Blue Cross in many regions of California, Blue Shield is working to make the transition for consumers who have enrolled in one of their health plans. They have released a bulletin about continuing care under a former health plan and transferring prescriptions to the new Blue Shield health plan.
As part of our ongoing efforts to manage these drug costs, we are expanding our precertification program to include medical specialty edits. The expansion of our precertification program will allow clients who currently have our precertification program to benefit from these enhancements. There are two components to this expansion:
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.
The letter will explain that Anthem Blue Cross has noticed a potentially risky pattern in the way they’re getting prescriptions filled. They will have 60 days to change this risky behavior. If Anthem Blue Cross doesn’t see a change in their drug claims within 60 days, they’ll follow up with another letter.
Some people qualify for big savings on their Medicare prescription drug costs and don’t even realize it! In fact, if you receive Medicare, you may be eligible for the Extra Help, which could save you about $4,000 per year on your monthly premiums, annual deductibles, and prescription co-payments.
Anthem, Inc. today filed suit against Express Scripts, its vendor for pharmacy benefit management services, to recover damages for pharmacy pricing that is higher than competitive benchmark pricing. The lawsuit also seeks to recover damages related to operational issues and for a declaration of Anthem’s right to terminate its contract with Express Scripts.
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:
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 […]