The goal of the Anthem National Drug List is to provide access to drugs and therapies with clinical evidence to improve the health of our members, while keeping health care affordable.
Our drug lists include brand-name and generic prescription medications that have been reviewed through our Pharmacy and Therapeutics (P&T) process. Through the P&T process, which includes an independent group of doctors, pharmacists and other health care professionals, we review new and existing drugs and choose medications based on safety, effectiveness and value. Reviews are conducted on a quarterly basis.
Additions are made quarterly while deletions may be made twice yearly, in April and October.
Effective April 1, 2017, in line with our Pharmacy & Therapeutics (P&T) quarterly formulary review process, we will modify our National Drug List to promote drugs with demonstrated clinical benefit for our members while delivering significant cost savings for our clients and plan members. As part of these changes, we will remove select brand drugs (58) with therapeutically comparable or favorable alternatives from our National Drug List. Only about 1% of members on our National Drug List will be redirected to a lower-cost medication with evidence of clinical benefit.
We are committed to a smooth transition by communicating with members and prescribers in advance to help members move, if needed, to clinically appropriate medications before the drug list changes are put in place. If a member’s medication is no longer covered, the member’s doctor can ask us to keep covering it by submitting a request for an exception. To do that, the member’s doctor can call us or visit anthem.com/pharmacyinformation.
The original Employer Notice from Anthem can be viewed here.
To find out more, contact your Anthem representative or call SIMA.