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Anthem Blue Cross (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 1-844-410-0746.

Machine Readable Data for Prescription Drug Formulary: Anthem BlueCross Medicaid Managed Care Machine Readable File


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

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