Pharmacy Benefits

For all of the 2018 Anthem medical plans:

 

‚ÄčClick here for 2019 Open Enrollment Information

 

2019 Pharmacy Information

 

Express Scripts Contact Information

 Service  Phone Number
 Member Customer Service (Non-Medicare)  1-877-554-3091
 Member Customer Service (Medicare Only)  1-844-468-0428
 Speciality Pharmacy Inquiries   1-877-248-1164
 Retail Pharmacy Help Desk (For pharmacists to call if they are having issues running your insurance)  1-800-922-1557                          
 Coverage Review Department (For your   provider to call regarding perscriptions   needing prior authoirzation)
 1-844-374-7377                    

 

To create an account with Express Scripts please visit www.express-scripts.com. You can manage your perscriptions, set up mail order, view the latest formulary, price a medication, print your ID card, and so much more.

Participating Pharmacies  (SB & SLO County)

 

2019 PPO & EPO Pharmacy Information

Anthem EPO Benefit Enhancement (Effective 1/1/2019):

All employees, excluding those enrolled in the HDHP, will now have the same pharmacy benefit. This change will reduce out of pocket maximum for those enrolled in the Anthem EPO plan.

Anthem Care PPO, Anthem Choice, Anthem Select & Anthem EPO

When Picking Up From an In-Network Retail Pharmacy

 Annual Out-of-Pocket Limit

$2,000 individual / $4,000 family

 Generic

$5 copay

 Preferred Brand

$20 copay

 Non-preferred Brand

$50 copay

 Supply 

30 days

You could possibly save money switching to mail order over picking up at a retail pharmacy if you are on any maintenance medications. Your co-pay for a 1-month supply of a generic medication at a pharmacy is $5 or you can get the same medication, but a 3-month supply, for a $10 co-pay through mail order. Log on to your online Express Scripts account for more information.

                                                               Anthem Care PPO, Anthem Choice, Anthem Select & Anthem EPO                                                                  

When Receiving a 3-Month Supply Through Mail Order

 Annual Out-of-Pocket Limit

$1,000 Mail Order

 Generic

$10 copay

 Preferred Brand

$40 copay

 Non-preferred Brand

$100 copay

 Compound Drug

N/A

 Supply

100 days

 

IMPORTANT HDHP PHARMACY NOTE:

You pay 100% of pharmacy costs until you meet the plan’s deductible.

This means if your prescription costs $100, you will need to pay the $100 each time you pick it up until you reach your deductible. You do NOT have a set co-pay. Once you meet your deductible, you will have co-insurance coverage, meaning you will pay 20% of your prescription’s cost. If your prescription costs $100 and you have met your deductible, you will pay 20% ($20) and the plan will cover the remaining 80% ($80). Once you reach your annual out-of-pocket maximum, the plan will pay 100%.

Anthem HDHP

In-Network Retail Pharmacy

 Annual Out-of-Pocket Limit

Medical Deductible Applies

 Generic

20%

 Preferred Brand

20%

 Non-preferred Brand

20%

 Supply Limit

30 days

Anthem HDHP

Mail Order

 Annual Out-of-Pocket Limit

Medical Deductible Applies

 Generic

20%

 Preferred Brand

20%

 Non-preferred Brand

20%

 Compound Drug

N/A

 Supply

100 days

Reference

Current Employee Benefit Menu