Anthem Blue Cross strives to improve the health of their members while providing access to affordable health care. As part of that effort, Anthem is committed to the ongoing evaluation of the safety and efficacy of drug therapies and to continuing to evolve their coverage policies based on new clinical evidence and real life experience.
As part of this commitment, Anthem, Inc., through their Pharmacy and Therapeutics (P&T) process, has announced changes to their formulary strategy for Epinephrine Auto-Injector Pens. This decision provides their members with a quality and more affordable option to treat allergic reactions, including anaphylaxis.
Beginning March 1, Anthem individual and employer-sponsored health plans will cover the authorized generic (AG) form of EpiPen on Tier 1. This change applies to the National, Essential, Preferred, Generic Premium and Select Drug Lists.
On April 1, the brand form of EpiPen will move from Tier 2 to non-formulary. Auvi-Q, which is currently on the Clinically Equivalent Medications (NDC Block) program, will move to non-formulary beginning 4/1. Brand and generic Adrenaclick will move to non-formulary on 4/1, as well. These changes apply to the National, Essential, Preferred and Generic Premium Drug Lists.
Current users will be given authorization to continue to get product until notification can be sent. For HIX, the generic form of EpiPen is added to Tier 1 on the Select Drug List; the brand form of EpiPen remains on Tier 2. For Medicaid, the generic form of EpiPen was added to the preferred drug list as of 1/1/17. For Medicare, generic EpiPen is covered by most plans. Current members on EpiPen or Adrenaclick will be grandfathered where required (e.g. California).