Anthem Blue MedicareRx Part D - Colorado

• Blue MedicareRx Value Plan - Evidence of Coverage Printable
• Blue MedicareRx Plus Plan - Evidence of Coverage Printable
• Blue MedicareRx Premier Plan - Evidence of Coverage Printable

• Blue MedicareRx Network Chain Pharmacies (Participating Medicare Part D Pharmacy Locator)

• Blue MedicareRx Application Printable Application

Forms:

Formulary Transition Notice

Prior Authorization Criteria

Request Form - Coverage Determination, Formulary Exception or Tiering Exception: Medicare Part D enrollees can use this form to request coverage determinations (including tiering or formulary exception requests) from their Medicare Part D plan sponsor.

Conditions and Limitations: By law, certain types of drugs or categories of drugs are not covered by Medicare Prescription Drug Plans. These drugs or categories of drugs are called "exclusions".

Out of Network Prescription Drug Coverage: Review the procedures for filling prescriptions outside of the network

Paper Claim Form for Prescription Drugs

Prescription Mail Order Forms
For more information on how this mail order program works and to download and complete the mail order form:
Prescription Mail Order Service

• Anthem Medicare Supplement Application Printable Application

• Look up your Pharmacy - Use our online Pharmacy Locator tool to quickly and easily see if your favorite local pharmacy is in our network of over 60,000 pharmacies nationwide. Click here for our Pharmacy Locator tool

• Order the Application

• Anthem Medicare Supplement ( A, C, F, I and J) - Medigap

• Anthem Medicare Supplement Application Printable Application

• Blue Cross and Blue Shield SmartValue PFFS - Premiums range from $0 to $56

(a Medicare Advantage Private Fee-for-Service organization. ) low cost plans

• Order the Application