Page 13 - Optima Tax EE Guide 01-20 CA

Prescription Drugs

The Anthem medical plans include prescription drug coverage for you and your covered dependents.
Retail Pharmacy
Use a retail pharmacy to fill prescriptions for acute conditions (conditions that do not
require the medication to be taken on a regular basis). At a participating pharmacy, you
will receive up to a 30 day supply of your prescriptions.

Mail Order Pharmacy – Maintenance Medication
You could pay less for the same medication when you use the mail order pharmacy. The
mail order pharmacy is a fast, easy and convenient way to save time and money on your
maintenance medications (drugs that you need to take regularly). You can order additional
supplies of medication at a discount. See below for details!
Anthem
Anthem Standard Anthem
Plan Name Basic PPO Network Only EPO Premier PPO

Deductible $0 $0 $0
Retail Pharmacy
Tier 1 (typically Generic) $10 $10 $10
Tier 2 (typically Preferred Brand) $25 $25 $30
Tier 3 (typically Non-Preferred Brand and Specialty) Not Covered Not Covered $50
Supply Limit 30 Days 30 Days 30 Days

Mail Order Pharmacy
Tier 1 (typically Generic) $20 $20 $20
Tier 2 (typically Preferred Brand) $50 $50 $60
Tier 3 (typically Non-Preferred Brand and Specialty) Not Covered Not Covered $100
Supply Limit Up to 90 Days Up to 90 Days Up to 90 Days

Specialty - Retail & Mail Order
Tier 4 (typically Preferred Specialty) 30% Max 30% Max 30% Max
$500 Copay $500 Copay $500 Copay
Supply Limit 30 Days 30 Days 30 Days

IMPORTANT: Prescription drugs are not covered when obtained through a non-network pharmacy.

Anthem Formulary Drug Search:
https://client.formularynavigator.com/Search.aspx?siteCode=2060134094

Pharmacy Tips

Use generic and over the counter drugs when available.
The best way to save on prescriptions is to use generic or over the counter medications as opposed
to brand name drugs. Generic drugs must use the same active ingredients as the brand name
version of the drug. A generic drug must also meet the same quality and safety standards.

Use the mail order benefit for maintenance medications
Save money and time by using the mail order pharmacy to fill your maintenance medications.

Employee Benefits 13