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Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) Formulary

The medications included in the Anthem formulary are reviewed and approved by the Pharmacy and Therapeutics Committee, which includes Practitioners and Pharmacists from the Provider community.

Please select a drug from the list below to see all coverage details regarding the medication. Some medications listed may have additional requirements or limitations of coverage. These requirements and limits may include prior authorization, quantity limits, age limits, step therapy or Center for Medicare and Medicaid Services (CMS) coverage requirements. 

Medications not listed on the formulary are considered to be non-formulary and are subject to prior authorization.

Additionally, if a medication is available as a generic formulation, this will be Anthem's preferred agent, unless otherwise noted. If you have any questions about coverage of a certain product, please contact us at 1-844-396-2330.

Machine Readable Data for Prescription Drug Formulary: Anthem BlueCross and BlueShield Healthcare Solutions Medicaid Machine Readable File


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*5-Ht4 Receptor Agonists****Acl Inhib-Intestinal Cholesterol Absorption Inhib Comb****Adenosine Deaminase Scid Treatment - Agents****Adenosine Receptor Antagonist****Adenosine Triphosphate-Citrate Lyase (Acl) Inhibitors****Adhd/Anti-Narcolepsy/Anti-Obesity/Anorexiants**Agents For Facial Lipoatrophy****Agents For Narcotic Withdrawal****Agents For Opioid Withdrawal****Als Agents - Miscellaneous****Alternative Medicine - Ag's****Alternative Medicine - Da's****Alternative Medicine - La's***Alternative Medicine - Li's****Alternative Medicine - Mo's****Alternative Medicine - Os****Alternative Medicine - Pe's****Alternative Medicine - Wo's****Alternative Medicines**Amebicides**Amino Acids****Aminoglycosides**Aminolevulinate Synthase 1-Directed Sirna****Aminomethylcyclines****Analgesic Combinations - Topical****Analgesics - Anti-Inflammatory**Analgesics - Nonnarcotic**Analgesics - Opioid**Androgen Combinations****Androgens-Anabolic**Anorectal Agents**Antacids**Anthelmintics**Antianginal Agents**Antianxiety Agents**Antiarrhythmics**Antiasthmatic And Bronchodilator Agents**Anti-Cataplectic Combinations****Anticoagulants - Misc.****Anticoagulants**Anticonvulsants**Antidementia Agent Combinations****Antidepressants**Antidiabetics**Antidiarrheal/Probiotic Agents**Antidiarrheals**Antidote Combinations****Antidotes And Specific Antagonists**Antidotes**Antiemetics - Antidopaminergic****Antiemetics**Antifungals**Antihemophilic Products - Monoclonal Antibodies****Antihistamines**Antihyperlipidemics Misc. Combinations****Antihyperlipidemics**Antihypertensives**Anti-Infective Agents - Misc.**Antimalarials**Antimyasthenic Agents**Antimyasthenic/Cholinergic Agents**Antimycobacterial Agents**Antineoplastic - Bcl-2 Inhibitors****Antineoplastic - Bispecific T-Cell Engagers****Antineoplastic - Fgfr Kinase Inhibitors****Antineoplastic - Hormonal And Related Agent Combinations****Antineoplastic - Methyltransferase Inhibitors****Antineoplastic - Tropomyosin Receptor Kinase Inhibitors****Antineoplastic - Xpo1 Inhibitors****Antineoplastic Or Premalignant Lesion Agent - Comb****Antineoplastics And Adjunctive Therapies**Anti-Obesity - Glp-1 Receptor Agonists****Anti-Obesity Agent Combinations***Antiparkinson Agents**Antipsoriatic Combinations****Antipsychotics/Antimanic Agents**Antiretrovirals - Cd4-Directed Post-Attachment Inhibitor****Antiretrovirals - Gp120-Directed Attachment Inhibitor****Antiretrovirals Adjuvants****Antisense Oligonucleotide (Aso) Inhibitor Agents****Antiseptics & Disinfectants**Antivirals**Anti-Von Willebrand Factor Agents****Assorted Classes**Atopic Dermatitis - Monoclonal Antibodies****Bacterial Monoclonal Antibodies****B-Complex W/ E & Folic Acid****Beta Blocker & Angiotensin Ii Receptor Antagonist Comb****Beta Blockers**Biguanide-Diabetic Supplies Combinations****Bile Acid Synthesis Disorder Agents****Biologicals Misc**Biotin W/ Vitamins C & E****Bulk Chemical Compound Kits****Bulk Chemicals - Ku****Bulk Chemicals - Ny****Bulk Chemicals - Os****Bulk Chemicals - Zo's****Calcitonin Gene-Related Peptide (Cgrp) Receptor Antag****Calcitonin Gene-Related Peptide Receptor Antag (Cgrp)****Calcium Channel Blocker-Nsaid Combinations****Calcium Channel Blockers**Cardiotonics**Cardiovascular Agents - Misc.**Casts, Splints & Accessories****Cephalosporin Combinations****Cephalosporins - Siderophores****Cephalosporins**Cgrp Receptor Antagonists - Monocolonal Antibodies****Chemicals**Cic Agents - Guanylate Cyclase-C (Gc-C) Agonists****Contraceptives**Corticosteroids**Cortisol Synthesis Inhibitors****Cough/Cold/Allergy**Cyclin-Dependent Kinases (Cdk) Inhibitors****Cystic Fibrosis Agent - Combinations****Dermatologicals**Diagnostic Products**Diagnostic Radiopharmaceuticals - Gases****Dietary Products/Dietary Management Products**Digestive Aids**Digestive Enzyme Cartridge****Digital Therapy****Direct-Acting P2y12 Inhibitors****Diuretics**Dopamine And Norepinephrine Reuptake Inhibitors (Dnris)****Endocrine And Metabolic Agents - Misc.**Erythroid Maturation Agents****Estrogen Combinations****Estrogen-Androgen-Progestin****Estrogen-Progestin-Gnrh Antagonist****Estrogens**Estrogen-Selective Estrogen Receptor Modulator Comb****Farnesoid X Receptor (Fxr) Agonists****Fentanyl Combinations****Fluorocyclines****Fluoroquinolones**Gaba Receptor Modulator - Neuroactive Steroid****Gastrointestinal Agents - Misc.**General Anesthetics**Genitourinary Agents - Miscellaneous**Glycopeptides****Gout Agents**Growth Hormone Releasing Hormones (Ghrh) Combinations****Hair Growth Agent - Combinations****Hematological Agents - Misc.**Hematopoietic Agents**Hemoglobin S (Hbs) Polymerization Inhibitors****Hemostatics**Hepatitis C Agent - Combinations****Hereditary Orotic Aciduria Treatment - Agents***Histamine H3-Receptor Antagonist/Inverse Agonists****Hydromorphone Combinations****Hypnotic Combinations****Hypnotics**Hypophosphatasia (Hpp) Agents****Ibs Agent - 5-Ht4 Receptor Partial Agonists****Ibs Agent - Mu-Opioid Receptor Agonists****Immunosuppressive Agents - Topical Combinations****Impotence Agent Combinations****Impotence Agents - Other****In Vitro Anticoagulant Combinations****In Vitro/Lock Anticoagulant Combinations****In Vitro/Lock Anticoagulants****Insulin-Incretin Mimetic Combinations****Insulin-Like Growth Factor-1 Receptor Inhibitors(Igf-1R)****Integrin Receptor Antagonists****Interleukin Antagonists****Interleukin-5 Antagonists (Igg1 Kappa)****Interleukin-5 Antagonists (Igg4 Kappa)****Interleukin-6 (Il-6) Antagonists****Isocitrate Dehydrogenase-1 (Idh1) Inhibitors****Isocitrate Dehydrogenase-2 (Idh2) Inhibitors****Ketone Monitoring Test Supplies****Laxatives**Leptin Analogues****Lhrh/Gnrh Agonist Analog Combinations****Local Anesthetics-Parenteral**Lymphocyte Function-Associated Antigen-1 (Lfa-1) Antag****Lysosomal Acid Lipase (Lal) Deficiency - Agents****Macrolides**Medical Devices**Medication Disposal Systems****Melanocortin Receptor Agonists (Uv Protective)****Melanocortin Receptor Agonists****Migraine Products**Minerals & Electrolytes**Misc. Antivirals****Miscellaneous Therapeutic Classes**Mixed Allergenic Extracts****Monobactams****Mouth/Throat/Dental Agents**Mucopolysaccharidosis Iv (Mps Iv) - Agents****Mucopolysaccharidosis Vii (Mps Vii) - Agents****Multiple Sclerosis Agents - Antimetabolites****Multiple Vitamins & Fluoride-Folic Acid****Multiple Vitamins W/ Minerals & Fluoride-Iron-Folic Acid****Multiple Vitamins With Folic Acid****Multivitamins**Muscular Dystrophy Agents****Musculoskeletal Therapy Agents**Nasal Agents - Systemic And Topical**Nasal Anesthetics****Neprilysin Inhib (Arni)-Angiotensin Ii Recept Antag Comb****Neurogenic Orthostatic Hypotension (Noh) - Agents****Neuromuscular Agents**N-Methyl-D-Aspartic Acid (Nmda) Receptor Antagonists****Nsaid Combinations****Nsaid-Dietary Management Combinations****Nsaid-Vitamins And/Or Minerals Combinations****Nutrients**Oncolytic Viral Agents - Hsv1****Ophthalmic Agents**Ophthalmic Gene Therapy****Ophthalmic Kinase Inhibitors - Combinations****Ophthalmic Local Anesthetic - Combinations****Ophthalmic Nerve Growth Factors****Ophthalmic Photoenhancer Combinations****Ophthalmic Rho Kinase Inhibitors****Ophthalmics - Blepharoptosis Agents***Opioid Antagonist Combinations****Orexin Receptor Antagonists****Otic Agents**Oxaborole-Related Antifungals - Topical****Oxytocics**Pa Endonuclease Inhibitors****Passive Immunizing Agents - Combinations****Passive Immunizing Agents**Pcsk9 Inhibitors****Pediatric Multiple Vitamins & Minerals W/ Fluoride****Pediatric Multiple Vitamins W/Fluoride-Iron-Zinc****Penicillins**Peritoneal Dialysis Solutions****Pharmaceutical Adjuvants**Phosphatidylinositol 3-Kinase (Pi3k) Inhibitors****Phosphodiesterase 4 (Pde4) Inhibitors - Topical****Phosphodiesterase 4 (Pde4) Inhibitors****Plasma Kallikrein Inhibitors - Monoclonal Antibodies****Pleuromutilins****Poly (Adp-Ribose) Polymerase (Parp) Inhibitors***Poly (Adp-Ribose) Polymerase (Parp) Inhibitors****Postherpetic Neuralgia (Phn) Combination Agents****Postherpetic Neuralgia (Phn)/Neuropathic Pain Agents****Postherpetic Neuralgia(Phn)/Neuropathic Pain Comb Agents****Potassium Removing Agents****Prenatal Mv & Min W/Fe-Fa & Coenzyme Q10****Prenatal Mv & Minerals W/ Fa Without Iron****Prenatal Mv & Minerals W/ Fa-Omega Fatty Acids W/O Iron****Prenatal Mv & Minerals W/Fa Without Iron****Progestins**Protease-Activated Receptor-1 (Par-1) Antagonists****Protein-Carbohydrate-Lipid With Electrolyte Combinations****Psychotherapeutic And Neurological Agents - Misc.**Pulmonary Fibrosis Agents - Kinase Inhibitors****Pulmonary Fibrosis Agents****Pulmonary Hypertension - Prostacyclin Receptor Agonist****Respiratory Agents - Misc.**Rosacea Combinations****Scar Treatment Products - Combinations****Sclerostin Inhibitors****Seborrheic Keratosis Products***Seizure Monitoring Products****Selectin Blockers****Selective Serotonin Agonists 5-Ht(1F)****Semi Solid Vehicle Combinations***Septal Agents - Ablation***Serotonin 1A Recept Agonist/Serotonin 2A Recept Antag****Serotonin Modulators****Sglt2 Inhibitor - Dpp-4 Inhibitor - Biguanide Comb****Sglt2 Inhibitor - Dpp-4 Inhibitor Combinations****Sinus Node Inhibitors***Small Interfering Ribonucleic Acid (Sirna) Agents****Snris & Anesthetics/Analgesics****Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb****Spinal Muscular Atrophy-Antisense Oligonucleotides****Spinal Muscular Atrophy-Gene Therapy Agents****Spinal Muscular Atrophy-Smn2 Splicing Modifiers****Spleen Tyrosine Kinase (Syk) Inhibitors****Steroids - Mouth/Throat/Dental****Sulfonamides**Surgical Sealants****Tetracyclines**Tetrahydroisoquinolines****Thickened Products****Thrombolytic Agent - Misc****Thyroid Agents**Topical Anesthetic Gases****Toxoids**Transcranial Magnetic Stimulators****Transthyretin Stabilizers****Tripeptidyl Peptidase 1 Deficiency Treatment - Agents****Tryptophan Hydroxylase Inhibitors****Ulcer Drugs**Urinary Analgesic Combinations****Urinary Anti-Infectives**Urinary Antispasmodics**Vaccines**Vaginal Contraceptive Ph Modulator - Combinations****Vaginal Products**Vasopressors**Vesicoureteral Reflux (Vur) Agent Combinations****Vitamins A & C****Vitamins A & D W/ K****Vitamins A & D W/ Minerals****Vitamins**X-Linked Hypophosphatemia (Xlh) Treatment - Agents***
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Formulary Effective Date: 10/21/2020
Updated:
10/2020

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