Changes to the Anthem Prescription Drug Formulary - effective April 1, 2019

This year Anthem presented a renewal for Jefferson Lab’s health insurance plan that included a substantial rate increase. The increase was based on Anthem’s underwriting formula, health insurance inflation, and the usage of the plan by Jefferson Lab employees and their covered dependents. Pharmacy costs continue to accelerate at a faster pace than other medical expenses. After reviewing the proposed rate increase and the impact that it would have on overall health insurance costs to employees enrolled in the plan as well as the increase in cost to the Lab, the decision was made to change the prescription pharmacy benefit to Anthem’s Essential Prescription Drug Formulary as of April 1, 2019. The change will bring overall savings to employees with limited disruption to plan participants.

Prescription Drug Formulary Change - A prescription drug formulary is the list of prescription drugs that are covered under your group health plan. Many insurance health plans, including Anthem, offer “closed formularies” to group health plans to help control prescription drug expenses. Anthem’s Essential Formulary is a “closed formulary.” It differs from the “open formulary” you currently have with KeyCare PPO and HealthKeepers POS plans because some prescription drugs on your current formulary may be excluded from the Anthem Essential Formulary. Anthem uses a highly qualified Pharmacy and Therapeutics Committee made up of network physicians and pharmacists to make sound decisions about what drugs are covered on the Essential Formulary list.  

Prescription medications that are not covered on the Essential Formulary have cost-effective, high-quality alternatives available to Jefferson Lab plan participants. There may be times when a member’s drug is not available on the Essential Drug Formulary. However, there may be a brand alternative, a generic equivalent, or an over-the-counter (OTC) option that’s a viable medication choice for you and/or your eligible dependent(s). If the covered alternative options are not suitable for you or your eligible dependent, the doctor can submit a request for an exception, known as prior authorization, which requires your treating physician to call Anthem’s Member Services number on your ID. Your treating physician can also submit a prior authorization electronically, which generally requires less processing time for Anthem to render an approval or denial decision to allow continued coverage for the existing medication. 

To view and search the complete and most up-to-date Essential Drug List follow this link to and under Formulary/Drug List, choose Essential Drug List (4-tier). Members may also call Member Services at the number listed on their ID card: 1-833-592-9956.