Quarterly pharmacy formulary change notice

The formulary changes listed in the table below apply to all Anthem HealthKeepers Plus members (FAMIS and Medallion) and Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) members. These changes were reviewed and approved at the fourth quarter 2019 pharmacy and therapeutics committee meeting.

 

Effective May 1, 2020, formulary changes, non-formulary changes and prior authorization (PA) requirements will apply.

Effective for all members on May 1, 2020
Therapeutic class	Medication	Formulary status change	Potential alternatives (preferred products)
PEDIATRIC MULTIPLE VITAMINS	(BRAND) POLY-VI-SOL  DROPS POLY-VI-SOL WITH IRON DROPS	PREFERRED	N/A
ADDITIONAL UM EDITS, EFFECTIVE NO LATER THAN AUGUST 1, 2020, CAN BE FOUND ON THE EXTENDED VERSION ON OUR PROVIDER PAGE

What action do I need to take?

 

Please review these changes and work with your Anthem HealthKeepers Plus patients and/or 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 PA to continue coverage beyond the applicable effective date.

What if I need assistance?

 

We recognize the unique aspects of patient cases. If your patients cannot be converted to a formulary alternative, call our Pharmacy department at 1-800-901-0020 (Anthem HealthKeepers Plus members) or 1-855-323-4687 (Anthem CCC Plus members) and follow the voice prompts for pharmacy PA. You can find the Preferred Drug List (formulary) on our provider website at https://mediproviders.anthem.com/va > Pharmacy > Medicaid Common Core Formulary > Common Core Preferred Drug List.

 

If you have any questions about this communication, call Provider Services at 1‑800‑901‑0020 or Anthem CCC Plus Provider Services at 1‑855‑323‑4687.

 

AVA-NU-0253-20