Jun 14, 2023
Support for individuals transitioning from Medicaid
As Medicaid eligibility reviews continue, disenrolled individuals seeking new coverage may be worried that their access to care and prescription medications will be disrupted when they change health plans. We’re working to avoid any disruption of their care or medicine as we help them find the right health plan to meet their needs.
We have teams focused on continuing care as individuals and families transition to a new plan. Those teams will contact new enrollees in Anthem Individual or Family plans who need care transition support. The teams focus on understanding these members’ specific health concerns and work with providers to coordinate necessary support, especially for those who require ongoing care.
Our First Fill program removes administrative barriers when transferring prescriptions from Medicaid to a new Anthem Individual and Family plan.
All existing prior authorizations for medication will automatically transfer to the member’s new plan within 30 days of the start of coverage. We will provide a one-time 30-day courtesy refill for non-formulary maintenance medicine that was covered by their previous plan. This will give the member time to work with their prescriber to submit a new long-term authorization request.
Please contact your Anthem representative for more information.
* Prior authorizations must meet quantity, cost, sensitive drug, etc. criteria for their new Individual plan benefit in order to be automatically transferred. In the event quantity, cost, sensitive drug criteria exceed plan benefits, a new PA initiated by the member’s primary care physician (PCP) is required.