National Direct Plus Drug List - Non-formulary medications and preferred alternatives
This document lists medications that are not included on the Anthem National Direct Plus Drug List (formulary) grouped by therapeutic class and provides preferred alternative medications that are on the formulary; it also describes the prior authorization/exception process for medications not on the list and points members/providers to online and phone resources.
No material clinical or coverage changes
Coverage summary
This document lists medications not included on the Anthem National Direct Plus Drug List, grouped by therapeutic class, with preferred alternatives and the exception/prior authorization process. Coverage stance: mixed.
The National Direct Plus Drug List is an open formulary with some closed classes. It is curated through a Pharmacy & Therapeutics process that considers effectiveness, safety, therapeutic class similarity, and affordability. Brand drugs may be excluded when generics are available.
National Direct Plus Drug List: Anthem's formulary of prescription medications approved for coverage; an open drug list with some closed classes.
Preferred alternative: A medication on the National Direct Plus Drug List recommended when a non-formulary medication is excluded.
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