Your Prescription Drug Coverage—2018

Your prescription drug coverage depends on the medical option you select.

Rx for Option A

  • Coverage is administered by Express Scripts.
  • You use your Anthem ID card at network pharmacies.
  • The plan pays for prescription drugs the same as other medical expenses:
    • After the annual medical deductible (including prescriptions) is satisfied, the plan pays 80% for prescriptions filled at network pharmacies and 60% for those filled at out-of-network pharmacies.
    • After you reach the medical out-of-pocket maximum, the plan pays 100% for covered prescriptions for the rest of the calendar year.

Rx for Options B and C

  • Coverage is administered by Express Scripts.
  • You use your Express Scripts ID card at network pharmacies.
  • After you meet the $75 per person annual prescription drug deductible, you pay:
At a retail pharmacy For up to a 30-day supply
Formulary brand
Non-formulary brand
20%, $5 minimum
25%, $20 minimum
35%, $35 minimum
Through home delivery For up to a 90-day supply
Formulary brand
Non-formulary brand
20%, $10 minimum
25%, $40 minimum
35%, $70 minimum
  • The out-of-pocket maximum applies to each covered person so there is no family out-of-pocket maximum. After your out-of-pocket costs reach the $930 annual per person prescription drug out-of-pocket maximum, the plan pays 100% of covered prescription costs for the rest of the calendar year.
  • The amount you pay depends on a drug formulary. A formulary is a preferred list of FDA-approved prescription drugs and supplies developed by Express Scripts’ Pharmacy and Therapeutics Committee. Drugs and supplies are included in the formulary, based on their clinical effectiveness and cost effectiveness. Drugs on the formulary typically have a lower copayment. Find out if your medication is on the formulary by calling Express Scripts at 1-866-282-0547 or by visiting the Express Scripts website.

Do you take a specialty drug? Important note: Specialty drugs are complex medications for specific conditions, such as multiple sclerosis, rheumatoid arthritis, blood disorders and hepatitis C. Some specialty drugs require special storage and handling and may not be readily available at your local retail pharmacy. After one fill at a retail pharmacy, specialty drugs must be filled through Express Scripts’ specialty pharmacy, Accredo. You will receive up to a 30-day supply and you’ll pay the retail copayment. For more information about filling a specialty drug prescription, visit the Express Scripts website.

If the prescription you fill at a retail pharmacy is for a specialty medicine, Express Scripts will notify you and provide information about refilling this medicine through Accredo.

Paying for Your Prescriptions

In-Network Pharmacies   

  • Show your ID card and buy:
    • Up to a 60-day supply for Option A
    • Up to a 30-day supply for Options B and C
  • No claim forms needed

Out-of-Network Pharmacies

3-step process:

  1. Pay the full cost of the drug.
  2. File a claim with Express Scripts.
  3. Receive reimbursement, up to the allowable charge minus any deductible or copayments.

Getting Your Medicines Just Got Easier

Prescriptions Delivered to Your Door

No matter which medical option you’re enrolled in, you can have your maintenance drugs conveniently mailed to your home. Ask your doctor to write a refillable 90-day prescription. Once your prescription is received by Express Scripts, it will be delivered to your door generally within 14 days. (Specialty drugs are dispensed for up to a 30-day supply.)

A Pharmacy on Your Phone

You can conveniently manage your prescription medications via a mobile application and mobile-optimized website available for smartphones. The mobile site and app allow you to start home delivery, order refills, check the status of an order, find drug information or even locate a retail pharmacy.

The mobile app, called Express Rx, is available on the iPhone and Android. Download it for free from the Apple App Store and the Android Market. Other smartphones, such as BlackBerry, can access the mobile website.

Prior Authorization and Quantity Limits

You can find a list of medications and/or quantities of medications before payment is authorized. You can find a list of medications requiring prior authorization by visiting the Express Scripts website.

Saving Money Through “Step Therapy”

The step therapy program requires you to try less expensive generic drugs or brand-name drugs before you receive certain brand-name drugs. This helps you better manage your prescription drug costs.

How It Works

If your doctor writes a prescription for certain brand-name drugs, Express Scripts will recommend that you try an alternative generic or brand-name drug first. Alternative drugs are chosen because they are as effective and usually cost much less.

Of course, the decision about your medications is up to you and your doctor. However, the amount you pay will depend on the type of drug you receive.