Your prescription drug benefits
Your prescription drug plan
Our prescription drug program manages more than 400 mil ion prescriptions each year. With a broad retail
pharmacy network, home delivery and a specialty unit that dispenses high-cost, biotech therapies, our
comprehensive approach helps you manage your pharmacy benefits.
Some members have a tiered drug list/formulary, or list of covered medications, which assigns drugs to
specific tiers based on cost. Tier 1 drugs have the most affordable copay . Tier 2 drugs cost slightly more,
and Tier 3 drugs have the highest copay amounts.
Your Prescription Drug 10-30-50 Plan
Generic medications are Mandatory
Prescription drugs wil always be dispensed as ordered by your physician. If you or your doctor requests a
brand name drug when a generic is available, you wil pay your usual copayment for the generic drug plus
the difference in the al owable charge between the generic and brand name drug.
Brand and generic drugs have the same active ingredient, strength and dose. And generics must meet the
same high standards for safety, quality and purity. If you’re taking a brand name drug, you could save money by switching to an effective, lower cost generic
drug. Your plan covers both brand and generic (or non-brand) drugs. When you choose a generic, you’l get the effectiveness of a brand drug – but usual y at a lower cost.
Why generics cost less
Developing a new drug is expensive. When a company creates a new drug, it gets a patent for up to 20
years. That means only the company that created it can sel it during that t ime. Once the patent expires,
other companies can make copies of the same drug. These companies avoid the high costs of developing
the drug – and that helps lower the price for you.
Talk to your doctor to see if a generic is right for you. Don’t switch or stop taking any drugs until you talk to
your doctor. Retail pharmacy network
Our network includes more than 56,000 pharmacies across the country. That means you have easy access
to your prescriptions wherever you are – at work, home or even on vacation. Using pharmacies in the network wil help you get the most from your drug plan. When picking up your prescription at the pharmacy, be sure to show your plan ID card.
Your prescription drug plan (continued)
To make sure your pharmacy’s in our network, visit anthem.com.
Log in and click on “Refil a Prescription.” You wil be directed to the Express Scripts website.
Click on “My Prescription Plan” in the left hand column. Click on “Find a Pharmacy.”
Choosing a non-network pharmacy means you’l pay the ful cost of your drug. Then, you may subm it a
claim form to be repaid. To access the form, visit anthem.com.
Log in and select the “Refil a Prescription” link. You wil be directed to the Express Scripts
Click on “My Prescription Plan” in the left-hand column, then click on “Coverage & Copayments.”
Note about your pharmacy information on the web:
Express Scripts is the company that manages the operations of your drug plan. The first time you’re
directed to the Express Scripts website, you’l go through a brief registration. The purpose is to set your
preferences for communication and privacy. You’l do this only once.
To access your pharmacy information, log on to anthem.com
. Home Delivery Pharmacy
Home delivery is for people who take medications on an ongoing basis. Our preferred Home Delivery
Pharmacy, managed by Express Scripts, sends you the medicine you need, right to your door. As a home delivery customer, you’l also enjoy:
Free standard shipping Access to pharmacists for drug questions
Getting started with home delivery
Switching is simple. You can order by mail or fax. Your order should arrive within 14 days from the date
your order is received. By mail:
to get an order form.
Log in and select “Refil a Prescription.” You wil be directed to the Express Scripts website. Click on “Fil a New Prescription.”
Choose the “Print a Prescription Order Form” link. You can print the form and complete it by hand.
Or you can fil out a web-based form and print it.
Mail your completed form, prescription from your doctor for a 90 day supply, and payments to:
Have your doctor fax your prescription and plan ID card information to 800-600-8105
. It must be
faxed directly from your doctor’s office. If there is a question about your prescription, the pharmacy wil
Your prescription drug plan (continued)
With home delivery, you don’t have to worry about running out of medication. That’s because the pharmacy
wil let you know when it’s time to order refil s. You can easily order by phone, mail or online: By phone:
Have your prescription label and credit card ready. Cal 866-281-4279
and select “Automated
Refil Order Line” option from the menu. Or press zero at any time to speak with a patient care advocate. If
you are speech or hearing impaired, cal 800-899-2114.
Fol ow the prompts to place your order.
Fil out an order form you received with a previous order. Affix your label or writ e the prescription
refil number in the space provided. Mail the order form with the proper payment to:
Log in and select “Refil a Prescription”. You wil be directed to the Express Scripts website.
Choose the drugs you want to refil , and click “Add Refil s to Cart.”
Review the order, shipping method, payment, medical information and contact information, and
CuraScript, the Express Scripts specialty pharmacy, provides support and medicine for people with
complex, long-term conditions. They include (but are not limited to):
Crohn’s Disease Growth Hormone
Psoriasis Pulmonary arterial hypertension
Respiratory syncytial virus (RSV) Transplant
Nurses, pharmacists and patient care advocates work together to help improve your care. Thei r goal is to help you get the best results from your treatments. CuraScrips CareLogic programs help people with the conditions listed on this page. These programs teach you about treatment for your condition and help you understand and cope with medication and side effects. CareLogic nurses and pharmacists will schedule time with you to find out how you are doing. They will also help you manage
the side effects of treatment. Call 888-773-7376 to learn about how CareLogic can help you better manage your health condition.
Your prescription drug plan (continued)
Ordering specialty drugs
You can place your first order by phone or fax:
Monday through Friday, 8 a.m. to 9 p.m. and Saturday 9 a.m. to 1 p.m.,
Eastern time. A patient care advocate wil help you get started.
Ask your doctor to fax your prescription and a copy of your ID card to 800-824-2642
. Ordering refills
Log in and select ‘Refil a Prescription.” You wil be directed to the Express Scripts website.
Chose the drugs you want to refil , and click “Add refil s to Cart.” Review the order, shipping method, payment, medical information and contact information and
Note: For some drugs, you must cal to order a refil .
Our drug list (sometimes cal ed a formulary) is a list of prescription drugs covered by your plan. It’s made
up of hundreds of brand and generic drugs.
We research drugs and select ones that are safe, work wel and offer the best value. That’s because we
think it’s important to cover drugs that help people stay healthy so they can work, go to school, and
continue the activities of a busy life.
Sometimes we update the Drug List if new drugs come to market, or if new research becomes available. To
view the current list, visit anthem.com
. Click on “Customer Care” in the top-right corner. Select your state,
then click “Download Forms."You’l find the Drug List on this page. If you don’t have access to a computer, you can check the status of a drug by cal i ng Customer Service at
the phone number on your plan ID card.
Over-the-Counter Prescription Drugs
The Plan also covers select over-the-counter (OTC) nicotine replacement products at either the Tier 1 (generic) copay
or Tier 3 (brand) copay provided you obtain a prescription from your Physician. A 30-day supply is available per
prescription at local participating retail pharmacies only.
• Nicotine patch (generic equivalents of NicoDermCQ®) • Nicotine gum (generic equivalents of Nicorette®) • Nicotine lozenges (generic equivalents of Commit®)
The Plan also covers select over-the-counter (OTC) drugs at the Tier 1 copay, provided you obtain a prescription from your Physician. A 30-day supply is available per prescription at local participating retail pharmacies only. Covered OTC medications include:
lansoprazole (generic equivalents of Prevacid OTC®)
omeprazole (generic equivalents of Prilosec OTC®/Zegerid OTCTM)
cetirizine (generic equivalents of Zyrtec OTC®)
fexofenadine (generic equivalents of Al egra OTC®)
Your prescription drug plan (continued)
loratadine (generic equivalents of Claritin OTC®/Alavert OTC®)
Most prescriptions are fil ed right away when you take them to the pharmacy. But, some drugs need our
review and approval before they’re covered. This process is cal ed prior authorization. It focuses on drugs
High potential for incorrect use or abuse
Better options that may cost you less Rules for use with very specific conditions
If your drug needs approval, your pharmacist wil let you know. To check in advance, cal the Customer
Service phone number on your ID plan card.
The Drug List also includes this information. To view it, visit anthem.com
. click on “Customer Care” in the
top-right corner. Select your state, then click on “Download Forms.” You’l find the Drug List on this page.
Anthem Blue Cross and its HMO af iliate, HealthKeepers, Inc., receives financial credits from drug manufacturers based on total volume of the
claims processed for their product utilized by Anthem Blue Cross and Blue Shield and Anthem HealthKeepers members. These credits are retained by Anthem Blue Cross and Blue Shield and HealthKeepers, Inc. as a part of its fee for administering the program for self-funded groups and used to
help stabilize rates for fully-insured groups. Reimbursements to pharmacies are not af ected by these credits.
Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its af iliated HMO,
HealthKeepers, Inc., are independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield
Association. This benefits overview insert is only one piece of your entire enrollment package. See the enrollment brochure for a list of your plan’s exclusions and limitations and applicable policy form numbers.
This summary of benefits has been updated to comply with federal and state requirements, including applicable provisions of the recently enacted federal health care reform laws. As we receive additional guidance and clarification on the new health care reform laws from the U.S. Department of
Health and Human Services, Department of Labor and Internal Revenue Service, we may be required to make additional changes to this summary of benefits.
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