Prescription Drug Coverage

When you enroll in a Capital One medical plan, you’re also automatically enrolled in prescription drug coverage through CVS Caremark—coverage is the same for all three medical plans. Your CVS Caremark information can be found on your Anthem Blue Cross Blue Shield ID card.

The addition of Pharmacy Advisor Counseling will provide support for patients in CVS stores. The service offers confidential advice, medication information, tips to help manage or avoid medication side effects and additional guidance. Also, additional controls may apply for certain high-cost medications and specialty medications. These controls include prior authorizations and requirements to try certain lower cost medications first.

Prescription Filling Options

Through the prescription program, you may fill prescriptions:

  • At a participating pharmacy for up to a 30-day supply. When you do, you pay a copay amount or you pay a percentage of the cost of the prescription—or co-insurance—with a minimum and maximum co-insurance amount. Prescription copays and co-insurance count towards your medical out-of-pocket maximum.
  • Through CVS Caremark’s mail-order pharmacy for a 90-day supply. Using the Maintenance Choice program will save you money and provide the convenience of having maintenance medication mailed directly to your home or address of your choosing. Or, you can elect to have your maintenance medications dispensed in a 90-day supply at a CVS pharmacy. CVS can work with you on payment options for your medications. Please contact CVS Caremark at 1-877-210-3556 or log in to caremark.com for more information regarding signing up for these programs.
  • A note on Specialty Medications: Certain medications are filled only through CVS Caremark’s specialty pharmacy. Please contact CVS Caremark at 1-877-210-3556 or log in to caremark.com for more information.
  • At the West Creek and Knolls Health Centers and Pharmacies. The West Creek and Knolls Health Centers offer a pharmacy for short-term medications (like antibiotics), 90-day supply for maintenance medications and a limited selection of over-the-counter medications. See Pulse for more information.
Prescription Costs

Your prescription cost reflects the type of medication that is used and the way you fill your prescription:

Type of Drug/Program Cost You Pay
Retail
(up to a 30-day supply)
Mail order
(up to a 90-day supply)
Generic $5 co-pay $10 co-pay
Formulary Brand 30% of retail cost ($35 minimum/$75 maximum) $75 co-pay
Non-Formulary Brand 50% of retail cost ($60 minimum/$125 maximum) $125 co-pay
Specialty

The Specialty Pharmacy program is designed to provide associates who routinely take medications for certain conditions with access to the best discounts and highest quality of medication available. Medication for these conditions can be purchased through the CVS Caremark Specialty Pharmacy, you may also obtain your specialty medication at a local CVS Pharmacy.

You pay for most Specialty medications based on retail co-insurance rates, whether obtained via mail order or at a local CVS pharmacy.

Your cost for non-medically necessary Specialty medications is 50% co-insurance with no minimum or maximum.

Be Well Pharmacy Discount Program

Available to patients with certain chronic conditions who work with Anthem nurses. Discounted pricing for 90-day prescriptions filled at CVS or via mail order:

  • Generic—$0
  • Brand formulary—$10
  • Non-formulary brand—$75

Note: Some prescriptions must meet defined criteria before they are covered by the plan.

PREFERRED DRUG LIST

A preferred drug list is a formulary list of drugs the plan has determined to be reasonable in cost and effective for treatment. A non-formulary drug also is effective for treatment, but isn’t as cost-effective as a formulary or generic drug. A group of practicing physicians and pharmacists routinely reviews drugs to include in a formulary. If clinical data shows several drugs are equally effective, the most cost-effective drug is usually chosen. The formulary may change from time to time. You can view CVS Caremark’s formulary at caremark.com.

Be Well Pharmacy Discount Program

You and your enrolled dependents may be eligible to receive reduced costs for the prescription drugs that help manage certain chronic conditions, including diabetes, hypertension, high cholesterol, asthma/COPD or congestive heart failure. Call an Anthem Nurse to qualify for the discount at 1-844-390-4133, press option 4 to speak with a nurse Monday through Friday from 8 a.m. to 11 p.m. ET.

RIGHT DRUG RIGHT CHANNEL MEDICAL TO PHARMACY PROGRAM

To better manage specialty drugs, we created the Right Drug Right Channel Medical to Pharmacy program. Under the program, certain self-administered drugs will not be covered under the medical benefit. These are drugs that associates can give themselves, without the help of a healthcare professional, so they’re best managed under the pharmacy benefit.