Important update on Botox® for Anthem members
- This is not a change in member benefits. This is a change in the Botox vendor only.
- If the member is not using IngenioRx Specialty Pharmacy or CVS Specialty Pharmacy to obtain Botox, no action is needed.
- This change will not affect any other specialty pharmacy coverage.
Medical specialty pharmacy benefits
Our members who currently obtain Botox through CVS Specialty Pharmacy using their medical specialty pharmacy benefits must move this prescription by January 1, 2022. Here are the options:
- Providers can purchase Botox for their patients, then supply it to Anthem members. Providers would then bill Anthem for the drug and administration of the drug. This will require a new prior authorization to notify Anthem of this change.
- If the Anthem member’s pharmacy benefit manager is IngenioRx, providers can transition the Botox prescription to receive the drug from any in-network pharmacy using their pharmacy benefits. Transferring the coverage will require a new prescription and new prior authorization.
For questions regarding a member’s medical specialty pharmacy benefits, call Provider Services using the information on the back of the member’s ID card.
Pharmacy benefits manager benefits
Effective January 1, 2022, members who currently obtain Botox through IngenioRx Specialty Pharmacy using their pharmacy benefits must move this prescription from IngenioRx Specialty Pharmacy to another in-network specialty pharmacy that dispenses Botox. If there are refills still available on the current prescription, members can transfer it to the new pharmacy. If not, members will need a new prescription.
For questions regarding a member’s pharmacy benefits, call Pharmacy Member Services using the information on the back of the member’s ID card.
November 2021 Anthem Provider News - Georgia