In December, Anthem Blue Cross and Blue Shield (Anthem) in Kentucky announced revised medical and pharmacy benefits to help those impacted by the recent storms in Kentucky. These revised benefits, effective Saturday, December 11, 2021, have been extended to Sunday, January 30, 2022.

 

These revised benefits apply to:

  • Members with Anthem group health plan benefits, individual and family plans.
  • Any emergency personnel who are Anthem members not residing in the impacted areas.
  • These revised guidelines DO NOT apply to Federal Employee Health Benefit Plan members, Medicare Advantage and Medicare Part D plans. Those business segments have their own unique guidelines and criteria.

 

Revised medical and pharmacy benefits

 

Pharmacy

  • 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 members to refill prescriptions at out-of-network pharmacies.
  • If an 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 members affected by the tornados.
  • Time limits for prior authorization, pre-certification or referral requirements will be relaxed.
  • There will be no late penalties for members impacted by the tornadoes who call in to request prior authorization or medical necessity reviews.

DME

  • Members impacted by the tornado 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.

 

434-0122-EM-KY



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Update: Benefits to those affected by storm emergency in Kentucky extended