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Anthem's New Pharmacy Networks & Opt-Out Home Delivery Program Explained

Oct 28, 2020

As part of Anthem Blue Cross's 2021 updates, they are introducing new pharmacy networks to help control costs along with a new Opt-Out Home Delivery Program.

 

Overview of Rx Networks

Anthem is changing the pharmacy networks on their small group plans. Most notably, all small group plans except the SHOP mirror plans are changing to Anthem's Rx Choice Tiered network. SHOP mirror plans will use the Standard network. All plans will continue to utilize the R90 Maintenance Network that allows members to receive a 90-day supply of coverage drugs from maintenance retail pharmacies for the same rate as home delivery. These changes apply to 2021 new business and current Anthem groups will get these updates at their 2021 renewal.

 

The following chart provides a little more information on these three networks and what they mean:

 

Network

What is it?

How does it compare to the current network?

Pharmacies included

Products impacted

Rx Choice Tiered network

Nationwide network with more than 67,000 retail pharmacies. Member choose between two levels of pharmacies: Level 1 (lower copay) and Level 2 (higher copay).

Current network is National network with the same pharmacies but without any copay differential.

Level 1 includes 25,000 preferred pharmacies like CVS, Target, Walmart, Sam’s Club, Kroger, Costco.

 

Level 2 includes non-preferred pharmacies like Walgreens, Rite Aid, Giant Eagle.

All Small Group plans except the SHOP mirror plans.*

Standard network

Nationwide network with approximately 59,000 retail pharmacies, excludes Walgreens and Walgreens-owned pharmacies.

Current network is National network which includes Walgreens.

Includes most national chains such as CVS, Target, Walmart, Sam’s Club, Costco, Kroger, Giant Eagle.

Only SHOP mirror plans.*

R90 network

Maintenance network that offers 90-day fills at retail.

This is a current benefit so there is no change.

99% of network pharmacies offer this option.

All Small Group plans.

 

*Shop mirror plans include: Platinum Select PPO 15/10%, Gold Select PPO 25/350/20%, Silver Select PPO 50/2250/30% and Bronze Select PPO 7000/0% w/HSA.

 

Rx Choice Tiered Network Overview

For plans that use the Rx Choice Tiered network, the member will see two different copays for each Rx tier. One copay will be for the Level 1 pharmacies and the other copay with be for the Level 2 pharmacies.

 

For example, on the Platinum PPO 5/250/15% benefit summary, Level 1 pharmacies would fall under the Preferred Network Provider, and Level 2 pharmacies under the In-Network Provider.

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On the SBC for the same plan, you'll also see Preferred for Level 1 and In-Network for Level 2.

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Rx Tiered Choice Pharmacy Listing

 

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Opt-Out Home Delivery

Anthem is promoting convenience and cost savings with their new Opt-Out Home Delivery program. There is no penalty for opting out. Here’s how their Opt-Out Home Delivery program works:

 

For members with medications taken regularly:

  • Members can obtain medications at the pharmacy for up to three courtesy refills.
  • The retail pharmacy will provide messaging that the member will be switched to home delivery unless they call to opt-out.
  • Members can also choose to get a 90-day supply at any CVS pharmacy at the same cost as home delivery.
  • Members will receive a letter when their courtesy fills run out.

 

For questions on these Anthem Blue Cross pharmacy updates, please contact a member of your B&P Sales Team - 888.722.3373.

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