Huntington Ingalls Newport News Anthem Key ... - Benefits Connect

What is covered - 25
To find a pharmacy that participates in the retail pharmacy network you should:
• refer to your health plan’s directory of network providers at www.anthem.com, which lists
pharmacies that participate in the retail pharmacy network;
• check with your local pharmacy to see if they participate in the retail pharmacy network; or
• call Anthem’s Member Services.
Pharmacies in the retail pharmacy network, available nationwide, will automatically file claims for you
and charge you only the required copayment amount under your health care plan for covered
prescriptions.
Anthem’s network pharmacies, available nationwide, will automatically file claims for you and charge
you only the required copayment amount under your health care plan for covered prescriptions.
You must have used 75% of your prescription before it can be refilled. However, in the following
circumstances, you can obtain an additional 30-day supply from your pharmacist:
• you’ve lost your medication;
• your medication was stolen; or
• your physician increases the amount of your dosage.
Anthem Blue Cross and Blue Shield and its pharmacy benefits manager (PBM) receive financial credits
from drug manufacturers based on the total volume of claims processed for their products utilized by
Anthem members. A portion of these credits are used to reduce plan costs and a portion is used by
Anthem as part of its fee for administering the program. Reimbursements to pharmacies are not
affected by these credits.
First-tier, second-tier,and third-tier drugs
The amount you will pay for a prescription drug depends on whether the drug you receive is a
first-tier, second-tier, or third-tier drug. Refer to the Summary of benefits to determine your
deductible (if any) and copayment amounts. If a generic drug is available, the generic drug will always
be dispensed, except when a physician orders a brand name drug. If your physician does not require
a brand name drug, you may request the brand name drug, and pay the difference in the maximum
allowed amount between the generic and the brand name drug, in addition to your second-tier or
third-tier copayment. By law, generic and brand name drugs must meet the same standards for safety,
strength, and effectiveness. Using generics generally saves you and your employer money, yet provides
the same quality.
Your prescription drug benefit includes the Half-Tablet Program. This program will allow covered
persons to pay a reduced copayment on selected “once daily dosage” medications. The Half-Tablet
Program allows you to obtain a 30-day supply (15 tablets) of the higher strength medication when
written by the physician to take “½ tablet daily” of those medications on the approved list. The
National Pharmacy and Therapeutics (P&T) Committee will determine additions and deletions to the
approved list. The Half-Tablet Program is strictly voluntary and your decision to participate should
follow consultation with and the concurrence of your physician. To obtain a list of the products
available on this program contact 800-962-8192.