Saving on Prescriptions

Understand your options to save on your prescriptions and stay well

CVS Caremark Prescription Coverage

When you enroll in an Anthem healthcare plan, you are automatically enrolled in the prescription drug benefit through CVS Caremark. Your formulary offers a wide selection of clinically sound, cost-effective generic, and brand-name prescription drugs. Additionally, CVS Caremark offers many convenient and affordable options to fill your prescriptions, such as retail pharmacies, mail-order, and specialty orders. The plan includes several utilization management programs to promote safety along with appropriate and cost-effective use of prescription medications. Your cost to fill a prescription depends on the healthcare plan you are enrolled, as well as, the drug tier.

While the majority of changes to the formulary occur on January 1 of each year, CVS Caremark reviews the standard and advanced specialty drug lists on a quarterly basis. During this review, covered medications may be added, removed or change the coverage tier. Each of these changes impacts your out of pocket costs.

Please review the updated drug lists effective July 1, 2024 (Preventive - All Plans) and October 1, 2024 (Standard, Specialty, Consumer Choice Preventive):

Note: If you are impacted by a formulary change, you will receive a letter directly from CVS Caremark notifying you of the change and any next steps.

Consumer Choice HSA

2024 Consumer Choice HSA Prescriptions

Annual out-of-pocket maximum	Combined with healthcare annual out-of-pocket maximum. See Healthcare Coverage Options.
Preventive medication	To promote good health and help prevent the need for costly care, the plan offers coverage for a number of preventive medications at $0 copayment and other preventive medications you can receive prior to meeting your deductible.
Retail (30-day supply)	You Pay Generic: 20% Preferred brand: 20% Non-preferred brand: 20%
Mail order (90-day supply)	You Pay Generic: 20% Preferred brand: 20% Non-preferred brand: 20%
Specialty	You Pay Generic: 20% Preferred brand: 20% Non-preferred brand: 20% 30 day limit for new specialty prescriptions

You can find the list of generic, preferred, nonpreferred drugs and specialty limits by visiting the CVS Microsite. Some medications may require prior authorization, may have quantity limits, change tiers, or be removed from the list of covered drugs known as the formulary. It is a good idea to periodically review your medications against the current formulary.

Comprehensive Care

2024 Comprehensive Care Prescriptions

Annual out-of-pocket maximum	Separate from healthcare annual out-of-pocket maximum. Individual: $1,750 Employee + 1: $3,500 Employee + 2 or more: $5,250
Preventive medication	To promote good health and help prevent the need for costly care, the plan offers coverage for a number of preventive medications at $0 copayment.
Retail (30-day supply)	You Pay Generic: $15 copay Preferred brand: 20%; $40 minimum, $100 maximum Non-preferred brand: 35%; $100 minimum, $200 maximum
Mail order (90-day supply)	You Pay Generic: $45 copay Preferred brand: 20%; $120 minimum, $300 maximum Non-preferred brand: 35%; $300 minimum, $600 maximum
Specialty	You Pay Generic: 20%; $75 maximum Preferred brand: 20%; $150 maximum Non-preferred brand: 35%; $200 maximum 30 day limit for new specialty prescriptions Employees approved for greater than a 30-day supply will pay 2x - 3x the applicable 30-day cost.

Blue Choice HMO

2024 Blue Choice HMO Prescriptions

Annual out-of-pocket maximum	Separate from healthcare annual out-of-pocket maximum. Individual: $1,750 Employee + 1: $3,500 Employee + 2 or more: $5,250
Preventive medication	To promote good health and help prevent the need for costly care, the plan offers coverage for a number of preventive medications at $0 copayment.
Retail (30-day supply)	You Pay Generic: $15 copay Preferred brand: 20%; $40 minimum, $100 maximum Non-preferred brand: 35%; $100 minimum, $200 maximum*
Mail order (90-day supply)	You Pay Generic: $45 copay Preferred brand: 20%; $120 minimum, $300 maximum Non-preferred brand: 35%; $300 minimum, $600 maximum*
Specialty	You Pay Generic: 20%; $75 maximum Preferred brand: 20%; $150 maximum Non-preferred brand: 35%; $200 maximum 30 day limit for new specialty prescriptions Employees approved for greater than a 30-day supply will pay 2x - 3x the applicable 30-day cost.

Generic and Brand-Name Drugs

If your doctor prescribes a brand-name drug when equivalent generic drugs are available, you will automatically receive an FDA-approved generic drug unless:

Your doctor writes “dispense as written” (DAW) on the prescription; or
You request the brand-name drug at the time you fill your prescription.

If you are taking a non-generic drug, talk to your doctor to determine if switching to a lower-cost generic medication may be an option for you. If you are taking ongoing maintenance medication, save time by getting your prescriptions conveniently delivered to you.

Kaiser Permanente Prescription Coverage

At most facilities, you can get your prescriptions filled on your way out the door.

Kaiser Permanente HMO

2024 Kaiser Permanente HMO Pharmacy

Annual out-of-pocket maximum	$1,500
Preventive medication	To promote good health and help prevent the need for costly care, the plan offers coverage for a number of preventive medications at $0 copayment.
Retail (30-day supply) At Kaiser Permanente pharmacies	You Pay Generic: $15 copay Preferred brand: $45 copay Non-preferred brand: $75 copay Specialty: 30%; $250 maximum
Mail order (90-day supply)	You Pay 3 x the applicable retail copay per 90-day supply

If you have questions or would like a copy of the USG preferred drug list, call 404-261-2590 or log into your KP Account.