Medical & Pharmacy
PLAN OVERVIEW
The medical plan is through Anthem and includes coverage for prescription drugs. All of the medical options include coverage for prescription drugs through Express Scripts. To select the plan that best suits your family, you should consider the key differences between the plans, the cost of coverage (including payroll deductions), and how the plan covers services throughout the year.
RESOURCES
Making the most of your plan
Getting the most out of your plan also depends on how well you understand it. Keep these important tips in mind when you use your plan.
- In-network providers and pharmacies: You will always pay less if you see a provider within the medical and pharmacy network.
- Preventive care: In-network preventive care is covered at 100% (no cost to you). Preventive care is often received during an annual physical exam and includes immunizations, lab tests, screenings and other services intended to prevent illness or detect problems before you notice any symptoms.
- Preventive drugs: Many preventive drugs and those used to treat chronic conditions like diabetes, high blood pressure, high cholesterol and asthma are on the Preventive Condition Drug List. These prescriptions are covered at 100% (no cost to you) when you use an in-network pharmacy.
- Mail Order Pharmacy: If you take a maintenance medication on an ongoing basis for a condition like high cholesterol or high blood pressure, you can use the Mail Order Pharmacy to save on a 90-day supply.
- Pharmacy coverage: Medications are placed in tiers based on drug cost, safety and effectiveness. These tiers also affect your coverage.
- Generic – A drug that offers equivalent uses, doses, strength, quality and performance as a brand-name drug, but is not trademarked.
- Brand preferred – A drug with a patent and trademark name that is considered “preferred” because it is appropriate to use for medical purposes and is usually less expensive than other brand-name options.
- Brand non-preferred – A drug with a patent and trademark name. This type of drug is “not preferred” and is usually more expensive than alternative generic and brand preferred drugs.
- Specialty – A drug that requires special handling, administration or monitoring. Most can only be filled by a specialty pharmacy and have additional required approvals.
