What You Need to Know
How much you’ll pay for prescription drugs depends on the type of medication and where you go to fill it. Your plan offers convenient home delivery for certain medications—one less thing you need to think about!
Your Prescription Drug Coverage
If you’re enrolled in an Anthem BCBS medical plan, your prescription drug coverage is provided by Express Scripts. If you’re enrolled in the Kaiser HMO, your prescription drug coverage is through Kaiser.
Your choices matter. You have options when it comes to filling prescription drugs, and the choices you make can help you save money:
- Choose lower-cost generic medications over brand-name drugs.
- Use participating (in-network) pharmacies.
- Utilize the mail-order service (up to a 90-day supply) for maintenance medications.
Here's what you pay for up to a 30-day supply from a retail pharmacy.
| Generic | Preferred Brand Name | Non-Preferred Brand | |
|---|---|---|---|
| Anthem BCBS CDHP | 20%, after deductible* | 20%, after deductible* | 20%, after deductible* |
| Anthem BCBS EPO and PPO | $10 co-pay | $20 co-pay | $35 co-pay |
| Kaiser HMO | $10 co-pay | $10 co-pay | $10 co-pay |
Out-of-pocket maximum. Your prescription drug expenses are included in the medical out-of-pocket maximum. If you reach the out-of-pocket maximum, the plan will pay 100% of the cost of your covered prescription drugs for the rest of the year.
Formulary. The formulary is the list of prescription drugs covered by the plan. If a prescription is not on the formulary, it will not be covered and you will have to pay the full cost out of pocket.
At-Home COVID-19 Testing
If you are enrolled a company-sponsored medical plan, effective January 15, 2022 and through the end of the public-health emergency, you can receive up to eight FDA-approved over-the-counter COVID-19 diagnostic tests per enrolled member per month.
Anthem BCBS medical plans
- Visit your local Express Scripts network pharmacy. To find a network pharmacy near you, log in to the Express Scripts pharmacy look-up tool.
- Bring the COVID-19 test kit(s) you wish to purchase to the pharmacy counter (not the standard checkout area) and show your Anthem ID card.
- Your test kit(s) will automatically ring up at no cost to you. A prescription is not required.
If you paid out of pocket on or after January 15, 2022, you can submit your receipt through the Express Scripts resource center for reimbursement — e.g., if there are issues processing the tests at the network pharmacy or if you are unable to use a network pharmacy (for reimbursement of up to $12 per test or $24 for a two-pack).
Kaiser HMO
Submit a claim to get reimbursed for tests purchased on or after January 15, 2022.
Prescription Drug Programs
Mandatory generics
You save money by choosing lower-cost generic drugs—medications that are equivalent to their brand-name counterpart in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use.
When you go to the pharmacy, your prescription will be filled automatically with a generic, unless your doctor has indicated “dispense as written.”
Mail-order pharmacy
Maintenance medications—those that you take on an ongoing basis—should be filled through the mail-order pharmacy whenever possible. You’ll pay less for a 90-day mail order prescription than you would for three separate fills of a 30-day prescription at a retail pharmacy. Your prescriptions are delivered right to your door—with free shipping! Plus, you can refill them from the website or mobile app.
| Generic | Preferred Brand Name | Non-Preferred Brand | |
|---|---|---|---|
| Anthem BCBS CDHP | 20%, after deductible* | 20%, after deductible* | 20%, after deductible* |
| Anthem BCBS EPO and PPO | $10 co-pay | $40 co-pay | $70 co-pay |
| Kaiser HMO† | $10 co-pay | $10 co-pay | $10 co-pay |
† 100-day supply available for the Kaiser HMO.
Express Scripts mail-order pharmacy
- Log in to the Express Scripts website.
- To use mail order, look for medications that indicate Transfer to Home Delivery, add that medication to your cart, and complete the checkout process.
Kaiser mail-order pharmacy
- Log in to the Kaiser website.
- To use mail order, go to Medications and select Transfer Prescriptions for any medication you want to move to mail order.
Voluntary Smart90
You can fill a 90-day supply of your maintenance medication at a CVS, Walgreens or Duane Reade pharmacy for the same price as using the mail-order pharmacy. That way, you’ll pay less than doing three separate 30-day fills.
Specialty medication pharmacy
You must fill certain specialty prescriptions through the Express Scripts specialty pharmacy—Accredo—or your prescription will not be covered. Contact Express Scripts for more information.
Lower-cost preventive medications
If you are enrolled in the Anthem BCBS CDHP medical plan, you’ll pay less for certain preventive medications—ones that help slow or stop the development of certain health conditions. If you are taking a drug on the Express Scripts Preventive Drug List, you will not have to meet your annual deductible before the plan starts paying benefits.
Express Scripts information on the go
Download the Express Scripts app to refill mail-order prescriptions, track your order, view prescription information, and more.
Find a Network Pharmacy
Express Scripts
- Log in to the Express Scripts pharmacy look-up tool.
- Search by zip code or city and state.
Kaiser
If you’re enrolled in the Kaiser HMO, you must fill your prescriptions through Kaiser or an affiliated pharmacy, including Rite Aid, Walgreens, and West Marin. To find a participating pharmacy:
- Go to the Kaiser pharmacy look-up tool.
- Select Locations, and enter Prescription as your search term.