Pharmacy

Prescription Drug Benefits

Prescription Drug Benefits offered through Anthem CarelonRx encourages the use of formulary medications. You can access your plan’s Rx formulary by logging in to the Anthem website www.anthem.com or using the Sydney mobile app. Use the Price of Medication tool to see the medications your plan covers and specific coverage requirements. If your medication is not listed, ask your doctor about an equivalent medication that is listed on the formulary. Connect with your Family Advocate if you have questions.

Resources:

• Base Network
• Formulary (PDF)
• Formulary (Searchable)
• Specialty Drug list  

 

Preventative Medication

Certain preventive medications are available at no cost to you. The list of preventive medications includes both prescription and over-the-counter (OTC) medications. For the plan to cover these medications, you will need a prescription from your doctor, even for the OTC products that are typically available without a prescription. Medications include aspirin, contraceptives, smoking cessation products, and vaccines among others. Log onto the Anthem Sydney app or Anthem site to see the full list.

Resources:

• ACA Preventive Drug List
• Enhanced Preventive Drug List

 

	Base High Deductible (HD)	Value High Deductible (HD)	Choice Open Access
Prescription Drug Benefits	National Preferred Formulary
Rx Deductible	Combined with Medical	Combined with Medical	$200 Individual $400 Family
Rx Out-of-Pocket Max	Combined with Medical	Combined with Medical	$3,100 Individual $6,200 Family
30-Day Retail Tiers 1/2/3 (Generic/Preferred Brand/Non-Formulary)	$15/$50/20% ($80 min–$400 max)	$15/$50/20% ($80 min–$400 max)	$15/$50/20% ($80 min–$400 max)
90-day Retail Tier 1/2/3 (Generic/Preferred Brand/Non-Formulary)	$30/$100/20% ($160 min–$800 max)	$30/$100/20% ($160 min–$800 max)	$30/$100/20% ($160 min–$800 max)

 

Pharmacy Home Delivery

Have your medication delivered to your home or other location with CarelonRx (Anthem’s pharmacy). You can manage your prescriptions on the Sydney app or www.anthem.com.

You’ll be able to track your order, set up reminders, and get auto-refills. Shipping is always free with CarelonRx. Your medication will be delivered via discreet packaging that is tamperproof, waterproof, and temperature controlled, as needed.

Many medications will cost less when you fill a 90-day supply.

 

Cost Relief

Certain specialty medications are eligible for the Anthem CarelonRx Cost Relief program. There’s no cost to participate! If you choose to participate, you’ll pay $0 for your medication.

Conditions supported by Cost Relief include, but are not limited to:

• Hepatitis C
• Multiple Sclerosis
• Psoriasis
• Inflammatory Bowel Disease
• Rheumatoid Arthritis
• Oncology

 

Retail Pharmacy Discount Programs

Pharmacies offer generic medication programs for 30 and 90–day supplies for less than $10. Several popular maintenance medications are offered through these generic programs. To take advantage of these programs, take your prescription to one of the participating pharmacies and present it to the pharmacist. You will not need to show your Provider ID card. It’s that easy to start saving money!

 

EnsureRx Pharmacy Discount Program

Maximize your prescription savings with your Anthem/CarelonRx coverage. CarelonRx has programs in place that automatically compare discount cards and coupons to ensure that you are receiving the lowest available cost on your medications. These discounts will be available to you when you check out at the pharmacy.

You can log onto www.anthem.com or use the Sydney mobile app to compare drug costs, locate the best in-network prices for your medications, and find discounts on drugs. You can also set up home delivery for your maintenance medications.