Medical Coverage Continued...
Using Prescription Drug Coverage Many FDA-approved prescription medications are covered through the benefits program. Regardless of the plan you have, you will save money by filling prescription requests at participating pharmacies. Additional important information regarding your prescription drug coverage is outlined below: • Anthem has drug formularies, or lists of prescription drugs including both generic and brand-name medications, with an applicable co-pay for each. If you obtain a medication that is not of the formulary list, you will pay the highest co-pay • Generic drugs are required by the FDA to contain the same active ingredients as their brand-name counterparts • A brand-name medication is protected by a patent and can only be produced by one specified manufacturer • Although you may be prescribed non-formulary prescriptions, these types of drugs are not on the insurance company’s preferred formulary list • Specialty medications most often treat chronic or complex conditions and may require special storage or close monitoring For a current version of the prescriptions drugs lists, visit the carrier’s website. A directory is included at the end of this benefit guide. The summary charts listed on the following pages contain plan coverage information. Prescription Tips Watching Your Wallet? Where can I find more Preferred Drug List information? You and your doctor can search for a drug, find out if it’s covered and see what tier it falls under. You can also see if there are alternatives that cost less. Make sure your doctor knows that you pay more for tier 3 drugs. He or she can consider this before writing a prescription. Please refer to www.anthem.com/ca for additional information on mail order service for lower co-pays on all prescriptions. Selecting a Plan that is Right for You As you evaluate your health plan options and insurance needs, consider the following factors: • CHOICE: If you prefer to obtain services from specific physicians, specialists or facilities, check to see if the medical plan option will cover services from those providers. While some health plans restrict your provider selection, others provide greater flexibility and choice • COVERAGE: Whether routine, surgical, prescription or another type of coverage, determine if the plan covers the services and medical treatments you value most. Plan exclusions, restrictions and limitations may also guide your selection process which are detailed in the Plan Summaries • COST: Cost may be a large determining factor in your selection and each plan may contain a variety of cost components. Consider the amount of your payroll deduction, as well as other plan expenses such as deductibles, co-payments or coinsurance
6 Benefits Guide 2024-25
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