Pricing of Medication
When you enroll in an Anthem medical plan, you are automatically enrolled in a four-tier prescription drug plan through Anthem CarelonRx that provides multiple options to save money.
| Prescription Drugs |
|---|
| |
Anthem Blue Cross
Exclusive |
Anthem Blue Cross
Preferred |
Anthem Blue Cross
HDHP* |
|---|
| |
Anthem PPO Network
In-Network Only
|
Anthem PPO Network
In-Network Only |
Out-of-Network |
Anthem PPO Network
In-Network Only |
Out-of-Network |
|---|
Out-of-Pocket Maximum
|
$2,000/Individual
$6,000/Family
|
$2,000/Individual
$6,000/Family |
Included with Medical
Out-of-Pocket Maximum |
| Pharmacy-Retail3 |
Tier 1: $10/copay1
Tier 2: 10%
($30 min./$250 max.)1
Tier 3: 10%
($50 min./$250 max.)1
Tier 4: 10%
($100 min./$250 max.)1 |
Tier 1: $10/copay1
Tier 2: 20%
($30 min./$250 max.)1
Tier 3: 20%
($50 min./$250 max.)1
Tier 4: 20%
($100 min./$250 max.)1 |
Tier 1, 2, 3 and 4:
35% up to $2501
|
Tier 1: $10/copay1
Tier 2: 10%
($30 min./$250 max.)
Tier 3: 10%
($50 min./$250 max.)
Tier 4: 10%
($100 min./$250 max.) |
Tier 1, 2, 3 and 4:
30% up to $250
|
Pharmacy-Mail Order3
Learn how to enroll here.
|
Tier 1: $20 copay1
Tier 2: 10%
($60 min./$500 max.)1
Tier 3: 10%
($100 min./$500 max.)1
Tier 4: 10%
($200 min./$500 max)1
|
Tier 1: $20 copay1
Tier 2: 20%
($60 min./$500 max.)1
Tier 3: 20%
($100 min./$500 max.)1
Tier 4: 20%
($200 min./$500 max)1 |
Not covered |
Tier 1: $20 copay1
Tier 2: 10%
($60 min./$500 max.)
Tier 3: 10%
($100 min./$500 max.)
Tier 4: 10%
($200 min./$500 max) |
Not covered |
*The HDHP Calendar Year Deductible is combined for Medical & Rx, except for Tier 1. Members are responsible for 100% of the discounted price for Tiers 2 through 4 until the Calendar Year Deductible is met. Then, the copay/cost share with Minimum Maximums will apply.
1Deductible does not apply Preauthorization required 3Coinsurance (including minimum and maximum allowed amounts) is per prescription 4Costs in excess of the plan's maximum allowed amount may apply (balance billing)
| |
Description |
|---|
| Tier 1 |
Lowest Member Cost Share: These drugs offer the greatest value compared to others that treat the same conditions. |
| Tier 2 |
Medium Member Cost Share: These may be preferred brand drugs based on their effectiveness and value. Some are newer, more expensive generic drugs. |
| Tier 3 |
Higher Member Cost Share: These generally include non-preferred brand and generic drugs. They may cost more than drugs placed on lower tiers that are used to treat the same conditions. |
Tier 4
|
Highest Member Cost Share: Many drugs on this tier are specialty drugs used to treat complex, chronic conditions and may require special handling and/or management. |
To find the "Tier" of your prescription, click on the following link to view Anthem's public prescription drug list. For details on how to view this list as it pertains to Marvell, you will need to log in to your Anthem account at anthem.com/ca and search for the formulary list. See below for details.
- Price your prescription: Log in to anthem.com/ca and find the cost of your medications using the "Price a Medication" tool located in the Prescription drop-down menu.
-
- By following these steps, you will see the expected amount you pay for the drug for a 90-day and 30-day prescription at various local pharmacies based on your zip code, as well as the mail-order cost if you order directly from Anthem CarelonRX.
- Find your prescription tier: You can find the tier of your medication by using the Anthem Prescription Drug List. PLEASE NOTE: This list is Anthem's public prescription drug list. Marvell's coverage has limitations and exclusions. This means that some drugs on this list may not be covered, depending on your plan’s design. For example, your plan might not cover certain drugs for cosmetic uses or to treat conditions such as weight loss, infertility, or erectile dysfunction. To find out if your drug is covered, log into your member portal or use the Sydney app to Price a Medication and refer to your plan documents.
To view this list as it pertains to Marvell, you will need to log in to your Anthem account at anthem.com/ca and search for the formulary list.
-
- Once you access the link, you can scroll down and enter your prescription in the search box.
- The page will refresh, and you will scroll down to find more information within the linked prescription provided.
- Click on your specified prescription, and a new window will appear with the tier information.
- If your doctor prescribes a brand-name medicine that's available as a generic, your pharmacy will give you the preferred generic option unless your provider indicates "Dispense as Written."
- If you are not an Anthem member, you can use pricing medication tools found on the internet, such as GoodRx. You'll still need to refer to the coverage of the medication on Marvellbenefits.com to determine the true copay/tier of the medication.
- For assistance, call Anthem CarelonRx at 1-833-261-2462 or contact your Anthem Family Advocate through the Sydney app or at anthem.com/ca.
Where to Get Your Medication
- Short-term medications: Prescriptions for up to 30 days can be picked up at any in-network pharmacy.
- Long-term medications: Prescriptions you take regularly (over 30 days) must be filled through CarelonRx mail order or picked up at an Anthem retail pharmacy for a 90-day supply. See the Rx Maintenance 90 program details below.
Rx Maintenance 90 (required for maintenance medication)
- Maintenance drugs you take regularly (over 30 days) for long-term conditions like asthma, heartburn, diabetes, etc., must be filled through mail order or picked up at an Anthem retail pharmacy for a 90-day supply. This is called the Rx Maintenance 90 program.
- The first 2-3 fills of your maintenance drugs for a 30-day supply and/or at a non-Anthem retail pharmacy will be covered; however, you will be asked to move your refill to a 90-day supply under this program. If you continue to refill your medication outside of the program, your cost will increase.
- Whether you choose an Rx Maintenance 90 pharmacy or CarelonRx's home delivery, you'll pay the same, lower home delivery copay.
- Current eligible long-term medications for this program are listed on the Rx Maintenance 90 drug list.
- For assistance moving your prescription to the Rx Maintenance 90 program, call Anthem CarelonRx at 1-833-261-2462 or your Anthem Family Advocate at 1-877-898-0739.
Mail Order Home Delivery Program
Mail Order Prescriptions: Request a new script from your physician and submit a request for a new mail order prescription through Anthem's pharmacy benefits manager, CarelonRx, by either:
- Logging into your account at anthem.com/ca choose Pharmacy, and on your personal pharmacy page select View Your Prescriptions under Switch to a 90-day Supply. For the drugs you want to switch to home delivery, choose Switch to a 90-day Supply and then Select Prescriber; you can also add your shipping address, options, and payment methods on this page.
- Complete and send the Mail Service Order Form.
For assistance, call an Anthem Family Advocate at 1-833-261-2462.
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