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Ways to Save with Anthem 51+ Pharmacy Benefits

Mar 11, 2009


Great ways to save with new pharmacy benefit designs

Several new benefit designs have been developed for groups of 51-250 and 126+ to help your clients and their employees save money on health care costs. These new benefit designs encourage members to use Anthem Blue Cross' mail service program, WellPoint NextRx, for routine prescriptions.

For Groups of 51-250 and 126+
1. Lower mail copayment
New, lower mail-order copayment designs offer members reduced copayments when ordering generic and formulary brand prescriptions from the mail service pharmacy. Members still have the option of filling prescriptions at a local retail pharmacy, but they'll get the most out of their benefit - and enjoy the greatest savings - by using Anthem Blue Cross' NextRx mail service pharmacy.

With this new copayment structure, Anthem Blue Cross' mail service pharmacy gives members greater supplies of maintenance medications for as little as one-third the cost:
2. Substantial savings for Lumenos plans
Starting with May 1, 2009, renewals, the newly introduced Lumenos products will include pharmacy copayments for participating pharmacy prescriptions. Once a member satisfies their plan deductible, they will pay pharmacy copayments of $10 generic/$30 brand/$50 brand non-formulary/30% for self-injectables. Once they reach their out-of-pocket maximum, pharmacy prescriptions will be covered in full!

Non-participating pharmacy expenses will continue to be offered as coinsurance. 

These plans will include the improved mail-order copay structure mentioned above. For plans with 100% in-network coinsurance, the out-of-pocket maximums will be increased by $1000 in network and $2000 out of network.

3. Rx Drug Benefit Changes
"Mandatory Generic Substitution" will now be implemented into all pharmacy plans. This means that if your employees request a brand drug when the generic equivalent drug is available, your employees will be able to receive the brand drug, but will pay the generic copay, plus the difference in the allowable charge between the brand-name and generic drug. 

For Groups of 126+ Only
Generic Premium Benefit
A new pharmacy benefit design exclusively for 126+ groups combines a generics-based formulary with select brand-name medications in highly utilized categories. This benefit, referred to as Generic Premium, includes most generic prescription medications - plus, typically, one or two brand-name prescription drugs in a therapeutic class.

The goal is to provide a cost-effective option to groups that may not be able to afford extensive coverage but are looking for more than a generics-only benefit design.

For more information about these new pharmacy benefits, please contact your Beere & Purves Sales Representative.
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