Prescription Drug Benefits

If you are enrolled in the Anthem PPO, your prescription drug benefits are administered by Express Scripts (ESI). If you are enrolled in the Kaiser HMO, your prescription drug benefits are administered by Kaiser.

You may take your prescription to a pharmacy that participates in Express Scripts’ network (for example, national chains like Sav-On, Smith’s, Safeway, CVS; regional drug store chains; and thousands of independently-owned pharmacies). However, after two fills, you need to use the Express Scripts PharmacySM mail order service for drugs to be taken for 31 days or more. To determine if your prescription is covered, how much is covered, whether you need to get prior authorization before filling your prescription, or you have other questions about your prescriptions, contact Express Scripts at expressscripts.com or (800) 987-7836.

Yes. You may fill a long-term prescription drug at a participating retail pharmacy up to two times (an initial fill and one refill). After that, you must fill your prescription through the Express Scripts Pharmacy mail order service. If you continue filling the prescription at a retail pharmacy, you’ll pay the entire cost of the drug. (Long-term drugs are those prescribed by your doctor for ongoing conditions, such as high blood pressure or high cholesterol.)

When you fill your prescription by mail order, you can save up to 60% on the cost and your medication will be delivered to your home with free standard delivery.

To get started with mail order, call Express Scripts at (800) 987-7836. For most medications, they will contact your doctor and arrange for your first home delivery supply. Your medication will usually arrive within eight to 11 days after your prescription is received. Continue to use a participating retail pharmacy to fill prescriptions for short-term drugs, such as antibiotics.

If the drug you are taking is not on Express Scripts’ formulary, contact your doctor to discuss alternative/Preferred medications or request a formulary coverage review by calling Express Scripts’ Coverage Review Department at (800) 753-2851.

To set up mail order, download, complete and mail the Express Scripts Home Delivery Order Form.

Have your Anthem participating doctor write a new 90-day prescription and submit it to Express Scripts as soon as possible after December 31, 2018. Your physician can write an emergency short-term prescription, to fill at your local in-network retail pharmacy, to cover you while you are waiting for your mail order medications to arrive.

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