Anthem Prescription Drug Program
www.anthem.com

 

Blue Access (PPO) Low, Middle and High Plans:

 

   
Prescription Drugs
Network Tier structure equals 1/2/3 (, if applicable)
     - Network Retail Pharmacies: (30 day supply)
       Includes  diabetic test strip
     - Home Delivery Service: (90 day supply)
       Includes diabetic test strip
Member may be responsible for additional cost when not selecting the available generic drug.
Medicare Rx - Wrap

Specialty Medications are limited up to a 30 day supply regardless of whether they are retail or mail service.




$10/$20/$30

$20/$40/$60




50%, min $30

Not covered

 

Lumenos Health Savings Account Plan:

 

   
Prescription Drugs:
     - Network Retail Pharmacies:
(30 day supply)
       Includes diabetic test strip
     - Home Delivery: (90 day supply)
       Includes diabetic test strip
     *4th Tier per script max - 30 day supply. Specialty medications are limited to a 30 day supply regardless
      of whether they are retail or home delivery.
     - Specialty Medications must be obtained via our Specialty Pharmacy network in order to receive
       network level benefits
     - Member may be responsible for additional cost when not selecting the available generic drug

$10/$30/$50/25% $150 max*

$10/$75/$150/25% $150 max*


 

50%, min $75

Not covered



 


Getting started with Home Delivery Pharmacy
    
If you take prescribed medicine on a regular basis, you can get up to a 90-day supply mailed right to your door. Here's how to start:

     Step One: See your doctor for a 90-day supply of your medicine
    
You'll need a 90-day supply of your prescription for your first Home Delivery Pharmacy order. But you should also ask your doctor to write you another prescription
     for an additional 30-day supply. This is so you can get the 30-day supply filled at your local pharmacy while your first Home Delivery order is being processed.

     Step Two: Contact the Home Delivery Pharmacy 
    
There are two ways you can put your first order in:
     1) Have your doctor fax us your prescription to 866-312-7456 (faxes can only be received from your doctor, so don't fax from your home or work)
     2) Go to anthem.com and download a form and mail it to the address below:
     - Log in then click on "Refill a Prescription". You'll be sent to the Express Scripts website.
     - Click on "Fill a New Prescription", then "Print an Order Form".
     - You can choose to print a blank form or one that has your information already on it.
     - Click on "Print Your Form".
     - Fill out the form and mail it with your prescription to:
          Home Delivery Pharmacy
          PO Box 66772
          St. Louis, MO 63166-6772

     Step Three: Pay for your prescription
    
- Pay online - Follow the directions above to the Express Scripts website. Then click on "My Profile & Settings" and enter your credit or debit card information.
     - Send in a check - enclose your payment with the prescription and form, and mail to the address above.

     Step Four: Receive your order
     - Your medicine will be sent to your home within two weeks from the time the Home Delivery Pharmacy gets your order.
     - If you need your medicine sooner, call 866-216-5449 to ask for your order to be sent overnight. You will be charged an additional fee.
     - Your order will be sent through the post office, UPS or FedEx. Please note, with some medicines, you may have to sign to accept delivery.
 

 

If applicable, all prescription drug expenses except tier 1, (Network Retail/Home Delivery-Service combined) apply to the individual Rx deductible. Once the Rx deductible is met, the appropriate copayment applies. Also if applicable, the Prescription Drug
   out of pocket maximum applies to Network Retail and Home Deliver-Service combined.

Rx non-network diabetic/asthmatic supplies not covered except diabetic test strips
 

 

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