Express Scripts
In and Out of network options
Prescription drug coverage for the Anthem BCBS medical plans is administered by Express Scripts.
Express Scripts offers mail order prescription services, a wide-ranging network of pharmacies with discounts, and a preferred retail network with even better discounts through national retailers which includes pharmacies within Target, Walgreens, Walmart, Kmart and a Community Pharmacy Network (CPN) of independent pharmacies.
You can use pharmacies in the Express Scripts network and the Preferred network. If you choose to go to an out-of-network pharmacy, your prescription drug will not be covered by the plan. Meaning, you will be responsible for the full cost of the medication, nor will the cost be credited towards your deductible.
How prescription drug costs are covered
If you are enrolled in the Premium Plus HSA, the Premium HSA or the Select HSA plan, prescription drugs are subject to the annual deductible and coinsurance. If you are enrolled in the Advantage HRA plan, prescription drugs are not subject to the deductible but the coinsurance does apply.
Preventive medications/supplies
Certain generic prescription medications and supplies are considered preventive. These medications are 100% covered and not subject to the annual deductible when obtained at a network pharmacy.
Preventive medications/supplies include the following conditions/drug classes*:
- Anti-angina
- Antiarrhythmics
- Anti-coagulants/Anti-platelets
- Asthma/COPD medications
- Bowel prep
- Diabetes medications and supplies — including insulin, lancets, and test strips (select brand)
- Heparins/Low molecular weight heparin
- High blood pressure medications
- High cholesterol medications
- Malaria medications
- Osteoporosis
- Select brand and generic respiratory medications
- SSRIs for depression treatment
- Preventive drugs/devices specified by the Affordable Care Act, such as contraceptives and tobacco cessation
Insulin pumps and insulin pump supplies are not included in preventive care and are subject to the annual deductible and coinsurance. They should be purchased through an in-network durable medical equipment provider.
*Not all medications in these drug classes are covered at 100%. Please refer to Express Scripts for coverage details.
Specialty medications
Specialty medications must be filled through Accredo Specialty Pharmacy for coverage under the plan. Prescriptions purchased at an out-of-network pharmacy are not covered under the plan.
