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 both CDHPs, certain approved preventive care drugs are covered in full.
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. Approved drugs are subject to change by the plan. For more detailed information on the plan’s formulary and whether coverage is available for certain drugs, call your plan’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 plan comparison chart [PDF] to see what you pay under each plan.
- Under each CDHP, certain approved preventive care drugs are 100% covered. Learn more about what’s covered and the cost to you:
- CVS Caremark [PDF]
- Kaiser Permanente [PDF]
- 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:
- CVS Caremark: 800-378-0780 or caremark.com
- Kaiser Permanente Northern California: 800-390-3510 or kp.org
- Kaiser Permanente Northwest: 800-813-2000
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.
Anthem PPO members who use specialty medications may save on some prescriptions by enrolling in the PrudentRx program. PrudentRx is a partner of CVS Caremark that will work with you to apply for drug manufacturers’ copay assistance for certain covered specialty medications.
If you are prescribed a covered medication, PrudentRx will call you to help you enroll in the program. Once enrolled, you will have a $0 copay for any covered specialty medication, even if it is not eligible for a manufacturer’s copay assistance program.
Where to learn more
- 2023 Plan Comparison Chart [PDF]
- CVS Caremark Covered Preventive Care Drugs [PDF]
- Kaiser Permanente Covered Preventive Care Drugs [PDF]
- CVS Caremark: caremark.com
- Kaiser Permanente Northern California: kp.org
- Kaiser Permanente Northwest Mail Order [PDF]