On July 29, 2022, Anthem Blue Cross and Blue Shield (Anthem) in Kentucky announced revised medical and pharmacy guidelines to help those impacted by the recent floods in eastern Kentucky in the following 14 counties: Perry, Floyd, Breathitt, Clay, Lee, Leslie, Letcher, Johnson, Knott, Pike, Martin, Magoffin, Owsley and Wolfe.

 

These emergency-based guidelines are effective from Thursday, July 28 through and including Friday, August 26, 2022 for impacted members in Kentucky.

 

These guidelines apply to members with Anthem group health plan benefits, individual and family health plans, Medicare Supplement, and Medicare Part D. These revised guidelines DO NOT apply to Federal Employee Health Benefit Plan members, or the Medicaid and Medicare Advantage programs. Those programs have their own unique guidelines and criteria.

 

Revised medical and pharmacy guidelines

 

Pharmacy

  • Impacted Anthem members may request a 30-day emergency prescription refill of maintenance medication.
  • Emergency personnel who are Anthem members not residing in the impacted areas may request a 30-day emergency prescription refill of maintenance medication.
  • Anthem will suspend refill limitations and allow impacted members to refill prescriptions at out-of-network pharmacies.
  • If an impacted Anthem member has pharmacy coverage through a pharmacy benefits manager (PBM) other than IngenioRx, the member will need to contact his or her PBM for details on how drug coverage will be handled.
  • Anthem’s specialty pharmacy line of business is excluded from these revised medical and pharmacy guidelines.

Prior authorizations and medical necessity reviews

  • Anthem will waive the notification time limit of medical necessity reviews for impacted members.
  • Time limits for prior authorization, pre-certification or referral requirements will be relaxed.
  • There will be no late penalties for impacted members who call in to request prior authorization or medical necessity reviews.

Claims filing

  • Timely filing consideration for claims filing upon request

DME

  • Impacted members can request replacement of durable medical equipment (DME) and supplies.

Out-of-network providers

  • Members can access out-of-network providers if an in-network provider is unavailable due to the state of emergency or if the member is out of the area due to displacement.

 

Contact us

If you have questions, please contact Provider Services.

KYBCBS-CM-004953-22



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Anthem responds to those affected by floods in eastern Kentucky