All medical plan options include prescription drug coverage. If you elect the Anthem CDHP with HSA or the Base PPO, CVS/caremark administers your prescription drug benefits. Kaiser provides prescription drug benefits for its CDHP and HMO options. Under the CDHP options, certain approved preventive care drugs are covered in full; see the list for Anthem [PDF] or Kaiser [PDF].
Note: Approved drugs are subject to change. Consult your plan for specific questions.
The prescription drug coverage includes a formulary, which is a list of generic, preferred and non-preferred drugs recommended by the plan for their efficacy and value. This list is subject to change by the plan. For more detailed information on the plan's formulary and whether coverage is available for certain drugs, call the provider's customer service number or visit its website.
Under the Anthem plans, prescription drug copays and coinsurance count toward the medical out-of-pocket maximum.
What You Need to Know
- Your costs will vary depending on the plan you choose. Use the detailed plan comparison chart [PDF] to see what you pay under each plan.
- Under the CDHP options, certain approved preventive care drugs are 100% covered. Learn more about what’s covered and the cost to you:
- Prescription drug coverage includes a list of preferred drugs that is subject to change by the plan throughout the year. Get detailed information on each plan’s preferred drug list:
Save on Prescriptions
Spending a few dollars less on regular prescriptions adds up to considerable savings in the long run. Consider these options to help your paycheck go further.
Mail Order vs. Retail
When you use a mail-order pharmacy service, you can get larger quantities of your prescriptions. If you’re enrolled in the Anthem Base PPO plan, you’ll pay $10 at a retail pharmacy to fill a 30-day supply of a generic drug prescription. By comparison, if you use the mail-order pharmacy service, you’ll pay $20 for a 90-day supply of that same medication.
If you're taking maintenance medication, mail order may be a better solution than having your prescription filled at a retail pharmacy every month. It may also cost you less. Learn more about the benefits of mail order service [PDF].
Generic vs. Brand Name
Most commonly used prescription drugs are available in less-expensive forms. If a generic form isn’t available, ask the pharmacist whether there’s an equivalent drug that has a generic form. Then check with your doctor to see whether the less-expensive drug might be right for you.
Where to Learn More
- 2019 Comprehensive Plan Comparison Chart [PDF]
- CVS Caremark Covered Preventive Care Drugs [PDF]
- Kaiser Permanente Covered Preventive Care Drugs [PDF]
- Fast Start (CVS Caremark): 1-800-875-0867 or caremark.com
- Kaiser Permanente Northern California: 1-800-390-3510 or kp.org
- Kaiser Permanente Northwest: 1-800-813-2000
- Benefits Help Desk: 1-877-291-9494