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Pharmacy and prescription drugs

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Your benefits include a wide range of prescriptions and over-the-counter medicines. We work with Express Scripts (ESI) to provide these benefits.

Find a pharmacy

To find a pharmacy near you, use the ESI pharmacy locator tool.


Find a pharmacy

Fill a prescription

Bring your member ID card and prescription to the pharmacy. Your doctor can also call in the prescription for you.

Copays

You don’t have a copay for your prescription drug benefits.

Drug coverage information

Preferred Drug List (PDL)

The Preferred Drug List (PDL) has the medicines your plan pays for as long as you have a prescription. This includes over-the-counter (OTC) medicines. Your doctor doesn’t have to check with the plan before prescribing these for you. The PDL is updated frequently.

View the Preferred Drug List

Don’t see it listed?

What if you don’t see your medicine listed on the PDL? You may ask for an exception at submitmyexceptionreq@anthem.com. You’ll be asked to supply a reason why it should be covered, such as an allergic reaction to a drug, etc.

Drug Lookup Tool

You can find out more about prescription medicines on the Drug Lookup Tool.

To use the Drug Lookup Tool, select here. Go to the top right corner and select Tools, Drug Lookup.

Prior authorizations (preapprovals)

Some medicines need a preapproval, or an OK, from Summit Community Care before your provider can prescribe them.

View a list of these medicines on the State’s website

For those medicines, your provider will need to call 1-844-462-0022 to get approval. If your provider needs approval from us before you can get your prescription filled, you may be able to get a 72-hour supply while you wait.

Drugs that require preapproval include those that:

  • Can have high side effect potential
  • Should be prescribed only for specific usage
  • Have a high misuse or abuse potential
  • May cost more than other preferred drugs (e.g. brand-name drug when an FDA-approved generic version is available)
  • Are part of a step therapy treatment plan
  • Are prescribed at a higher dosage than recommended

The preapproval process helps us make sure that you’re taking medications safely and correctly. If you misplace your medicine or it is stolen, contact your provider. They will work with the pharmacy and Summit Community Care to review your case and replace your medicines as needed.

 

Drug interactions and side effects

Learn more about drug interactions or side effects on the Express Scripts Drug Information page.

 

Related information

Express Scripts (ESI) forms

If you had to pay for a medicine covered under your plan, you may submit a request for reimbursement form.

You can manage your prescriptions online through ESI.

Mail order prescriptions

You can fill your prescription at a retail pharmacy or for your convenience, you can get many prescription drugs shipped directly to your home through an in-network home delivery provider.

Get the Express Scripts App

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Express Scripts phones image
Apple iTunes - Download Express ScriptsGoogle Play - Download Express Scripts

Manage your medicines with ease anytime, anywhere with this free app.

Use the app to:

  • Set reminders to take or reorder your meds
  • Find a pharmacy near you
  • Get your pharmacy history and personal alerts