The formulary changes listed in the table below apply to all Anthem HealthKeepers Plus and Commonwealth Coordinated Care Plus (Anthem CCC Plus) patients. These changes were reviewed and approved at the first quarter 2018 Pharmacy and Therapeutics Committee meeting.

 

Effective August 1, 2018, formulary changes applied.

 

EFFECTIVE FOR ALL PATIENTS ON AUGUST 1, 2018
SECOND NOTICE:  ADDITIONAL INFORMATION PROVIDED
(PREFERRED NDC'S LISTED)


Therapeutic class

Drug NAME

Preferred

Manufacturer

Preferred

NDC

OTC Prenatal Vitamins

 PRENATAL TABLET 28MG-0.8MG

21ST CENTURY HE

40985-0273-10

OTC Prenatal Vitamins

DAILY PRENATAL COMBO PACK 28-800-440

PRENATAL VITAMINS TABLET 28MG-0.8MG

AMERISOURCEBERG

46122-0009-65

46122-0098-78

OTC Prenatal Vitamins

PRENATAL TABLET 27MG-0.8MG

CARDINAL HEALTH

55154-1393-00

OTC Prenatal Vitamins

QC PRENATAL TABLET 28MG-0.8MG

CHAIN DRUG

35515-0947-74

63868-0001-01

OTC Prenatal Vitamins

CVS PRENATAL MULTI-DHA SOFTGEL 27-0.8-250

CVS PRENATAL VITAMIN TABLET

CVS WOMEN'S PRENATAL + DHA 28-975-200

CVS

50428-0399-50

50428-2525-77

50428-4604-61

OTC Prenatal Vitamins

PRENATAL 19 TABLET 29-1-25 MG

PRENATAL 19 CHEWABLE TABLET 29 MG-1 MG

CYPRESS PHARM.

60258-0196-01

60258-0197-01

OTC Prenatal Vitamins

KPN TABLET

PRENATAL ONE DAILY TABLET 27MG-0.8MG

FREEDA VITAMINS

10432-0033-01

58487-0031-31

OTC Prenatal Vitamins

PRENATAL TABLET 27MG-0.8MG

GENDOSE PHARMAC

77333-0715-10

77333-0715-25

OTC Prenatal Vitamins

PRENATAL TABLET 27MG-0.8MG

GERI-CARE

57896-0575-01

OTC Prenatal Vitamins

GNP DAILY PRENATAL COMBO PACK 28-800-440

GNP PRENATAL VITAMINS TABLET 28MG-0.8MG

GOOD NEIGHBOR

87701-0405-76

87701-0407-99

OTC Prenatal Vitamins

HM PRENATAL TABLET 28MG-0.8MG

HEALTH MART

52569-0134-33

OTC Prenatal Vitamins

PERRY PRENATAL CAPSULE 13.5-0.4MG

KIRKMAN SALES

11763-0522-01

OTC Prenatal Vitamins

PRENATAL TABLET 28MG-0.8MG

LEADER

96295-0128-31

OTC Prenatal Vitamins

PRENATAL TABLET 27MG-0.8MG

MAGNO-HUMPHRIES

43292-0555-15

43292-0556-70

OTC Prenatal Vitamins

PRENATAL TABLET 27MG-0.8MG

MAJOR PHARMACEU

00904-5313-46

00904-5313-60

OTC Prenatal Vitamins

PRENATAL FORMULA TABLET 28MG-0.8MG

NAT'L VIT. CO.

54629-0052-01

79854-0400-70

OTC Prenatal Vitamins

PRENATAL TABLET 28MG-0.8MG

PLUS PHARMA;INC

37864-0837-01

51645-0837-01

OTC Prenatal Vitamins

PRENATAL TABLET 27MG-0.8MG

PRIME MARKETING

62107-0063-01

OTC Prenatal Vitamins

PRENATAL TABLET 28MG-0.8MG

RICHMOND PHARM

54738-0050-01

OTC Prenatal Vitamins

RA PRENATAL TABLET 28MG-0.8MG

RA ONE DAILY PRENATAL DHA PACK 28-800-440

RITE AID CORP.

11822-3089-10

11822-4898-00

OTC Prenatal Vitamins

CLASSIC PRENATAL TABLET 28MG-0.8MG

PRENATAL VITAMINS TABLET 28MG-0.8MG

RUGBY

00536-4063-01

00536-4085-01

OTC Prenatal Vitamins

PRENATAL VITAMIN TABLET 28MG-0.8MG

SAFECOR HEALTH

48433-0112-01

 


What action do I need to take?

 

Please review these changes and work with your Anthem HealthKeepers Plus and Anthem CCC Plus patients to transition them to formulary alternatives. If you determine formulary alternatives are not clinically appropriate for specific patients, you will need to obtain prior authorization to continue coverage beyond the applicable effective date.

 

What if I need assistance?

 

We recognize the unique aspects of patients’ cases. If your Anthem HealthKeepers Plus patient cannot be converted to a formulary alternative, call our Pharmacy department at 1‑800‑901‑0020 and follow the voice prompts for pharmacy prior authorization. You can find the Preferred Drug List (formulary) on our provider website at https://mediproviders.anthem.com/va.

 

If you need assistance with any other item, contact your local Provider Relations representative or call Provider Services at:

  • 1-800-901-0020 (Anthem HealthKeepers Plus).
  • 1-855-323-4687 (Anthem CCC Plus).



Featured In:
December 2018 Anthem Provider Newsletter - Virginia