HealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsNovember 30, 2018
Quarterly pharmacy formulary change notice
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).
PUBLICATIONS: December 2018 Anthem Provider Newsletter - Virginia
To view this article online:
Visit https://providernews.anthem.com/virginia/articles/quarterly-pharmacy-formulary-change-notice-2-1186
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