CVS/Caremark Rx Benefits

Anthem Blue Cross Plans I, II, and III provide prescription drug benefits through CVS/Caremark.

Non-Maintenance Medication (Retail Pharmacy)

Short-term medications, up to a 34-day supply, are available at network retail pharmacies. CVS/Caremark’s network includes more than 68,000 pharmacies nationwide, including chain pharmacies and CVS/Caremark Pharmacy locations. Present your Anthem Blue Cross ID card with CVS/Caremark information on the back to a pharmacist, along with each prescription, to ensure correct claims processing.

Retail Pharmacy Purchase Information

In-Network

You pay for your prescription when you receive your medication. The pharmacy will calculate the 20 percent coinsurance at the time of purchase, after applying your deductible. Plan III does not have a deductible.

Non-Network Pharmacy

You submit a claim form directly to Caremark for reimbursement. Anthem Blue Cross reimburses you for 60 percent of reasonable and customary charges, after applying your deductible. Plan III does not have a deductible.

If you do not live within the CVS/Caremark service area, you will be reimbursed for 80 percent of reasonable and customary charges, after applying your deductible. Plan III does not have a deductible.

Maintenance Medication (Mail Order and Maintenance Choice®)

For participants who take maintenance prescriptions for chronic medical conditions and specialty drugs. A maintenance medication is one taken regularly for chronic conditions or long-term therapy, such as managing high blood pressure, asthma, diabetes, or high cholesterol.
Ninety-day supplies of maintenance medications are available via mail order or Maintenance Choice®.

Mail Order Service (Up to a 90-Day Supply)

You receive up to a 90-day supply of maintenance medications for one small copayment (no deductible is required). Obtain a 90-day supply maintenance prescription from your doctor and have it filled through Mail Order. Approximately 10 to 14 days after CVS/Caremark receives your order, you will receive your prescriptions in the mail, along with information about your medications, a receipt, and a new order form.

CVS/Caremark Maintenance Choice®

30-day fills of maintenance medications can be filled (no fill limits) at any participating CVS/CAREMARK network pharmacy. You will pay the 20 percent retail coinsurance after you meet the annual deductible.

90-day fills of maintenance medications can be filled at CVS pharmacies (including those inside Target stores) or through Mail Order service. Using these options, you pay the copay amounts ($10 – Generic Drugs, $30 Preferred brand drugs, $50 Non-preferred brand drugs).

Maintenance Prescription Medications Summary of Options

Any Network Retail Pharmacy Up to a 30-day supply:

• Generic Drugs, Preferred Brand Drugs and Non-Preferred Brand Drugs require 20 percent coinsurance*
• Fill limit for long-term medications have no limit

Maintenance Choice® (Filled at CVS/Caremark Pharmacy) Up to a 90-day supply:

• Generic drugs - $10 copay
• Preferred brand drugs - $30 copay
• Non-preferred brand drugs - $50 copay
• Fill limit for long-term medications have no limit

Mail Order Service Up to a 90-day supply

• Generic drugs - $10 copay
• Preferred brand drugs - $30 copay
• Non-preferred brand drugs - $50 copay
• Fill limit for long-term medications have no limit

*After you meet the annual deductible. Note: Anthem Blue Cross Plan III does not have deductibles.

Specialty Prescription Drugs

Specialty prescription drugs are used to treat complex or rare conditions, such as rheumatoid arthritis, osteoporosis, cancer, anemia and multiple sclerosis. Specialty prescription drugs are available only by mail through Caremark Specialty Pharmacy Services, unless they are dispensed in your physician’s office. To fill your prescription, you must register with Caremark Specialty Pharmacy Services by calling 800-237-2767. Your applicable plan design copay will apply.

Specialty Prescription Drugs Benefit Copays

• $150 copay mail order only (3-month supply)
• 1–30-day supply — $50
• 31–60-day supply — $100
• 61–90-day supply — $150