Prescription drug benefits for the Consumer Choice Plan are provided through Medco for the Anthem Blue Cross and Blue Shield (Lumenos) administered Consumer Choice Plan. Prescription drug benefits for the Consumer Choice Plan administered through BlueCross BlueShield (BCBS) are provided through Prime Therapeutics.
Prescription drugs are covered the same as any other expense in the Consumer Choice Plan. Prescription drug expenses count towards your combined medical/pharmacy deductible and out-of-pocket maximum. You pay 20% after the deductible for up to a 30-day supply of medication when you use a participating retail pharmacy and 40% after the deductible if you use an out-of-network retail pharmacy. While prescriptions are covered the same way as other eligible medical expenses, when you use a participating pharmacy the cost of the medication is discounted, lowering your out-of-pocket cost in most cases.
Once you’ve met your annual deductible, you will be responsible for 20% for prescriptions filled using the discounted mail order pharmacy benefit for up to a 90-day supply.
If you visit a pharmacy that does not offer discounts, you will have to pay the full price at the time of service, then file a claim for reimbursement. You will be reimbursed for 60% of the discounted cost. You are responsible for your coinsurance as well as the difference between the discounted amount and the amount charged by the out-of-network pharmacy.
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Questions about your employee benefits or other Human Resources issues? Contact the Workplace Solutions Center at (888) 471-2271.