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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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Brand Name, Generic Name or NDC Code Search


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*Adhd/Anti-Narcolepsy/Anti-Obesity/Anorexiants* - Drugs For The Nervous System*Allergenic Extracts/Biologicals Misc* - Biological Agents*Alternative Medicines* - Vitamins And Minerals*Amebicides* - Drugs For Infections*Aminoglycosides* - Drugs For Infections*Analgesics - Anti-Inflammatory* - Drugs For Pain And Fever*Analgesics - Nonnarcotic* - Drugs For Pain And Fever*Analgesics - Opioid* - Drugs For Pain And Fever*Androgens-Anabolic* - Hormones*Anorectal And Related Products* - 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*Anticoagulants* - Drugs For The Blood*Anticonvulsants* - Drugs For The Nervous System*Antidepressants* - Drugs For The Nervous System*Antidiabetics* - Hormones*Antidiarrheal/Probiotic Agents* - Drugs For The Stomach*Antidotes And Specific Antagonists* - Drugs For Overdose Or Poisoning*Antiemetics* - Drugs For The Stomach*Antifungals* - Drugs For Infections*Antihistamines* - Drugs For The Lungs*Antihyperlipidemics* - Drugs For The Heart*Antihypertensives* - Drugs For The Heart*Anti-Infective Agents - Misc.* - Drugs For Infections*Antimalarials* - Drugs For Infections*Antimyasthenic/Cholinergic Agents* - Drugs For Nerves And Muscles*Antimycobacterial Agents* - Drugs For Infections*Antineoplastics And Adjunctive Therapies* - Drugs For Cancer*Antiparkinson And Related Therapy Agents* - Drugs For The Nervous System*Antipsychotics/Antimanic Agents* - Drugs For The Nervous System*Antiseptics & Disinfectants* - Antiseptics And Disinfectants*Antivirals* - Drugs For Infections*Beta Blockers* - Drugs For The Heart*Calcium Channel Blockers* - Drugs For The Heart*Cardiotonics* - Drugs For The Heart*Cardiovascular Agents - Misc.* - Drugs For The Heart*Cephalosporins* - Drugs For Infections*Chemicals**Contraceptives* - Drugs For Women*Corticosteroids* - Hormones*Cough/Cold/Allergy* - Drugs For The Lungs*Dermatologicals* - Drugs For The Skin*Diagnostic Products**Dietary Products/Dietary Management Products* - Drugs For Nutrition*Digestive Aids* - Drugs For The Stomach*Diuretics* - Drugs For The Heart*Endocrine And Metabolic Agents - Misc.* - Hormones*Estrogens* - Hormones*Fluoroquinolones* - Drugs For Infections*Gastrointestinal Agents - Misc.* - Drugs For The Stomach*General Anesthetics* - Drugs For Pain And Fever*Genitourinary Agents - Miscellaneous* - Drugs For The Urinary System*Gout Agents* - Drugs For Pain And Fever*Hematological Agents - Misc.* - Drugs For The Blood*Hematopoietic Agents* - Drugs For Nutrition*Hemostatics* - Drugs For The Blood*Hypnotics/Sedatives/Sleep Disorder Agents* - Drugs For The Nervous System*Laxatives* - Drugs For The Stomach*Local Anesthetics-Parenteral* - Drugs For Pain And Fever*Macrolides* - Drugs For Infections*Medical Devices And Supplies* - Medical Supplies And Durable Medical Equipment*Migraine Products* - Drugs For The Nervous System*Minerals & Electrolytes* - Drugs For Nutrition*Miscellaneous Therapeutic Classes* - Vitamins And Minerals*Mouth/Throat/Dental Agents* - Drugs For The Mouth And Throat*Multivitamins* - Drugs For Nutrition*Musculoskeletal Therapy Agents* - Drugs For Muscles, Ligaments, Tendons, And Bones*Nasal Agents - Systemic And Topical* - Drugs For The Nose*Neuromuscular Agents* - Drugs For Nerves And Muscles*Nutrients* - Drugs For Nutrition*Ophthalmic Agents* - Drugs For The Eye*Otic Agents* - Drugs For The Ear*Oxytocics* - Hormones*Passive Immunizing And Treatment Agents* - Biological Agents*Penicillins* - Drugs For Infections*Pharmaceutical Adjuvants**Progestins* - Hormones*Psychotherapeutic And Neurological Agents - Misc.* - Drugs For The Nervous System*Respiratory Agents - Misc.* - Drugs For The Lungs*Sulfonamides* - Drugs For Infections*Tetracyclines* - Drugs For Infections*Thyroid Agents* - Hormones*Toxoids* - Biological Agents*Ulcer Drugs/Antispasmodics/Anticholinergics* - Drugs For The Stomach*Urinary Antispasmodics* - Drugs For The Urinary System*Vaccines* - Biological Agents*Vaginal And Related Products* - Drugs For Women*Vasopressors* - Drugs For The Heart*Vitamins* - Drugs For Nutrition
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Formulary Effective Date: 01/01/2022

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