Page 7 - 2017 Employee Benefit Highlights

Saving time and money
Anthem prescription program

The amount you pay for your prescription drugs is dependent
on the type of drug. The Anthem PPO Drug/List Formulary is To learn more about the PPO Drug
grouped into 4 tiers: List/Formulary and stay on top of the
latest changes, visit anthem.com.

TIER 1 | Generic drugs
Retail $10 copay per 30-day supply, Retail90 and Mail order 3X copay (90-day supply)
Generic drugs are the least expensive drugs that, by federal law, contain the exact same
active ingredients as their brand name equivalents. They must also meet stringent FDA
approvals for safety and effectiveness. What is mandatory generic?
Mandatory generic prescription
TIER 2 | Preferred brand name drugs drug coverage encourages the use of
Retail $25 copay per 30-day supply, Retail90 and Mail order 3X copay (90-day supply) generic drugs by filling a prescription
Drugs on this tier are generally the more affordable brand name drugs. Other drugs are with a generic drug, where available
on this tier because they are “preferred” within their therapeutic classes (such as anti- and appropriate, at the generic copay.
depressants, blood pressure medications, gastrointestinal drugs, etc), based on clinical If you choose to purchase a brand-
effectiveness and value. The formulary changes frequently so a preferred brand drug this name drug over the generic drug
year could become a non-preferred brand or generic at anytime. when the generic drug is available
and appropriate, you will be required
TIER 3 | Non-preferred brand name drugs to pay the brand copay plus the
Retail$50 copay per 30-day supply, Retail90 and Mail order 3X copay (90-day supply) difference in cost between the brand
These are higher cost brand-name drugs. Some Tier 3 drugs may have generics or and generic if a generic equivalent is
equivalents in Tier 1. In addition, some drugs on this tier may have been evaluated to be available (up to the cost of the brand
less cost-effective than equivalent drugs on lower tiers. name drug).

TIER 4 | Specialty drugs
Specialty Pharmacy Program 20%, up to $200 maximum per prescription (30-day
supply) available through a Specialty Pharmacy. Refer to SPD for retail order details.
Many drugs on this tier are “specialty” drugs used to treat complex, chronic conditions Example of what drugs really cost and how
and may require special handling and/or management, such as those used to treat generic alternatives can save you money:
hepatitis, rheumatoid arthritis and multiple sclerosis. (example refers to Anthem PPO in-network
pharmacy.)
Retail pharmacies | when you need a prescription in a hurry Cholesterol reducing
prescription:
You’ll get the most from your Anthem prescription benefits if you use a participating
Generic Brand names
retail pharmacy. Simply show your ID card at the pharmacy and pay the appropriate
copay or out-of-pocket expense, for up to a 30-day supply of drugs. The Retail90 program simvastatin Crestor Lipitor
20 mg
20 mg
20 mg
allows you to pick up a 90-day supply of maintenance drugs for 3 times the 30-day retail Retail
copay. There are no claims to file. Choosing a non-network pharmacy means you’ll pay copay $10 $25 $50
30-day supply
the full cost of your prescription. For a list of participating pharmacies, log on to anthem. Retail only
com or contact customer care at the phone number listed on your member ID card. plan costs
30-day supply $147 $218 $262
Mail order | convenient for daily medications Retail90
Home delivery is available for prescriptions such as cholesterol-lowering drugs, anti- copay $30 $75 $150
90-day supply
depressants, high blood pressure medication and more. You’ll get a 90-day supply for a Mail order
3-month copay, and it takes only a few steps to place your order. Refer to Easy Answers copay $30 $75 $150
90-day supply
on page 20 to find out how to download a Home Delivery Pharmacy Order Form. Tier 4 Mail order
Specialty Drugs must be ordered through the Specialty Pharmacy Program. plan cost $353 $785
$443
All copays on the PPO plan, including pharmacy, will apply to the annual 90-day supply
out-of-pocket maximum. 6