Prescription Drugs
All of the medical plans include retail and mail-order prescription drug coverage. Benefits are provided by:
- Anthem if you enroll in an Anthem medical plan. See how drugs are covered by Anthem. (To view the Essential Formulary, click on “Essential Drug List 4-Tier (Searchable).”)
- Kaiser Pharmacy if you enroll in a Kaiser medical plan. See how drugs are covered by Kaiser.
Anthem Pharmacy Programs
The following pharmacy programs are designed to help save you money on prescriptions.
Anthem Essential Formulary: The Anthem medical plans use the Essential Formulary, which is a smaller, cost-saving formulary drug list compared to the National Formulary. The Essential Formulary is meant to control costs while maintaining quality. You can view the Essential Formulary on the Anthem website. Click on “Essential Drug List 4-Tier (Searchable).”
Anthem Tiered Choice pharmacy network: With Anthem’s Tiered Choice, network pharmacies are grouped into Level 1 and Level 2.
- Level 1: Anthem medical plan members pay their current prescription drug copays at over 25,000 pharmacies, including CVS, Costco, Target, Walmart, and more.
- Level 2: Anthem medical plan members have access to more pharmacy options; however, they will pay an additional $10 copay (or an additional 10% for specialty drugs)
Paying for Prescriptions
There is no annual deductible for prescription drugs, so you begin paying copays with your first prescription purchase. The category, or tier, your drug is in determines the amount you pay. See the Medical Plan Comparison Chart for coverage amounts.
Save Money
Here are tips to help you save on your prescription drug costs:
- Ask your doctor about generics. Generic medications are generally just as effective as brand-name medications, but they cost between 30% and 75% less.
- Use mail order. If you regularly take medication to treat a chronic condition — such as an allergy, heart disease, high blood pressure, or diabetes — using the mail order prescription service will save you time and money. Visit your medical plan carrier’s website or call the number on the back of your insurance ID card to use this service.
Prescription Drug Coverage Comparison
| Plan Details | Anthem Vivity HMO Plan | Kaiser HMO Plan | Anthem HMO Plan |
| Retail (30-day supply) | |||
| Tier 1 | $15 copay | $15 copay | $15 copay |
| Tier 2 | $35 copay | $35 copay | $35 copay |
| Tier 3 | $70 copay | $35 copay | $70 copay |
| Tier 4 | 20% coinsurance; maximum $150 copay per fill | 30% coinsurance; maximum $150 per prescription | 20% coinsurance; maximum $150 copay per fill |
| Mail Order (Anthem is 90-day supply; Kaiser is 100-day supply) | |||
| Tier 1 | $15 copay | $30 copay | $15 copay |
| Tier 2 | $70 copay | $70 copay | $70 copay |
| Tier 3 | $140 copay | $70 copay | $140 copay |
| Tier 4 | 20% coinsurance; maximum $300 copay per fill | Retail only | 20% coinsurance; maximum $300 copay per fill |
| Plan Details | Anthem EPO Plan | Anthem EPO Plan | Anthem PPO Plan |
| Retail (30-day supply) | |||
| Tier 1 | $15 copay | $15 copay | $15 copay |
| Tier 2 | $35 copay | $35 copay | $35 copay |
| Tier 3 | $70 copay | $35 copay | $70 copay |
| Tier 4 | 20% coinsurance; maximum $150 copay per fill | 30% coinsurance; maximum $150 per prescription | 20% coinsurance; maximum $150 copay per fill |
| Mail Order (90-day supply) | |||
| Tier 1 | $15 copay | $30 copay | $15 copay |
| Tier 2 | $70 copay | $70 copay | $70 copay |
| Tier 3 | $140 copay | $70 copay | $140 copay |
| Tier 4 | 20% coinsurance; maximum $300 copay per fill | Retail only | 20% coinsurance; maximum $300 copay per fill |