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Pharmacy

If you are quarantined or asked by your doctor to get an additional supply of prescription drugs during the COVID-19 crisis, you can get a single refill before the normal refill date by calling Anthem Medicare Prescription Drug Member Services at (833) 279-0460. Your request will usually be approved the same day or within 24 hours. Pharmacy help is available 24/7.

How the Plan Works What's Covered and What You Pay for Prescription Drugs Filling Prescriptions Money-Saving Options Getting Help

How the Plan Works

Your medical coverage includes Medicare Part D drug benefits and non-Medicare supplemental drug benefits.

Because this is a Medicare Part D plan, the UC Medicare Prescription Drug Plan (PDP) is required to track and notify you of your Part D drug costs, the amount you pay out-of-pocket and your current coverage level or “stage.” For each month that you obtain Part D prescription drugs, you will be mailed an Explanation of Benefits (EOB) that outlines the information. This is for tracking purposes only. The EOB is not a bill.

Pharmacy benefits are administered by Anthem Blue Cross. Log in to Anthem to access a variety of tools—from viewing the Medicare Part D Formulary and Extra Covered Drugs List to finding local in-network pharmacies, accessing tools to find low-cost medication options, and getting forms and information about home delivery. In general, there is no coverage for out-of-network pharmacies.

Anthem provides resources for managing your prescription drug coverage. Visit Anthem to access a variety of tools to find local in-network pharmacies, choose the lowest-cost medication option, access forms and get information about home delivery.

What’s Covered and What You Pay for Prescription Drugs

The plan covers generic and brand-name drugs, including high-cost specialty drugs, which goes beyond the minimum standard Medicare requires. Your coverage also includes hundreds of additional Extra Covered Drugs not normally covered by Medicare Part D.

Your prescription drug benefit includes coverage for medications on the Part D Formulary. The drug list—also called a formulary—is composed of drugs approved for the U.S. Food and Drug Administration (FDA), including brand-name and generic drugs. Medications on the list are grouped into four tiers.

  • Tier 1: These are typically generic drugs that offer the lowest-out-of-pocket costs and greatest value compared to other medications that treat the same condition.
  • Tier 2: These may be preferred or brand-name drugs or more expensive generic medications.
  • Tier 3: These are typically non-preferred and some specialty drugs, which could include those recently approved by the FDA.
  • Tier 4: These are typically specialty drugs used to treat complex, chronic conditions. Tier 4 drugs typically have the highest out-of-pocket costs.

For questions about what's covered and your costs, call Anthem Medicare Prescription Drug Member Services, toll-free, at (833) 279-0460, Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific).

What You Pay

Drugs Covered by Medicare Part D

Changes Coming for 2021
For details about the 2021 plan changes, see the UC virtual benefits guide. Select See Current Plan > UC Medicare PPO.

 

UC Pharmacies & Participating Anthem Pharmacies

Deductible

None

Out-of-pocket Maximum

None

True Out-of-pocket Maximum (TrOOP)

The most you'll pay for covered Medicare Part D prescriptions in a calendar year.

$6,3501
Retail network pharmacies (30-day supply)

(Preferred Generic) Tier 1: $10

(Preferred Brand) Tier 2: $30

(Non-Preferred) Tier 3: $45

(Specialty) Tier 4: $30

UC pharmacies and select retail pharmacies—CVS, Walgreens, Costco, Safeway/Vons (90-day supply)

(Preferred Generic) Tier 1: $20 

(Preferred Brand) Tier 2: $60 

(Non-Preferred) Tier 3: $90

(Specialty) Tier 4: $60

Retail network pharmacies (90-day supply)

(Preferred Generic) Tier 1: $30 

(Preferred Brand) Tier 2: $90 

(Non-Preferred) Tier 3: $135

(Specialty) Tier 4: $90

Mail order (90-day supply)

(Preferred Generic) Tier 1: $20 

(Preferred Brand) Tier 2: $60

(Non-Preferred) Tier 3: $90

(Specialty) Tier 4: $60

1. For PPO plan members: You continue to pay the cost of Extra Covered Drugs, even after the TrOOP is reached.

Select Generic Drugs

Affordable medication is one of the many things that adds to your long-term well-being and peace of mind. Your UC pharmacy benefits include no cost generic drugs used to treat some of the most commonly prescribed conditions, including diabetes, hypertension and high cholesterol—with zero out‑of‑pocket expenses to you at any in-network retail or mail-order pharmacy. All Select Generics have proven track records for effectiveness and value.

This sample list includes some commonly-prescribed drugs. For a complete list, call Anthem Medicare Prescription Drug Member Services at (833) 279-0460.

 

Cardiovascular

Atenolol tablet

Atenolol/ chlorthalidone tablet

Benazepril hcl tablet

Benazepril hcl/ hydrochlorothiazide tablet

Bisoprolol/ hydrochlorothiazide tablet

Captopril tablet

Captopril/ hydrochlorothiazide tablet

Chlorthalidone tablet

Enalapril maleate tablet

Enalapril/ hydrochlorothiazide tablet

Hydrochlorothiazide capsule/tablet

Irbesartan tablet

Irbesartan/ hydrochlorothiazide tablet

Lisinopril tablet

Lisinopril/ hydrochlorothiazide tablet

Losartan potassium tablet

Losartan potassium/ hydrochlorothiazide tablet

Metoprolol tartrate tablet

Ramipril tablet

Valsartan tablet

Valsartan/ hydrochlorothiazide tablet

Cholesterol

Lovastatin tablet

Pravastatin sodium tablet

Simvastatin tablet

Diabetes

Glimepiride tablet

Glipizide ER tablet

Glipizide tablet

Glipizide/metformin hcl tablet

Metformin hcl ER tablet

Metformin hcl tablet

Osteoporosis

Alendronate sodium tablet

Extra Covered Drugs

These are drugs that are often excluded from Part D coverage but are covered by your UC pharmacy benefit. Coverage includes prescription medications for cough and cold, vitamins and minerals and lifestyle drugs, including those used to treat erectile dysfunction (ED). Extra Covered Drugs do not count towards your True Out of Pocket expenses. For more information about what's covered, see the Anthem drug list.

What You Pay

Covered Drug You Pay

Prescription Cough and Cold,
Vitamins and Minerals, and
Lifestyle Drugs

Generic: Retail or mail-order copayment
Preferred Brands: Retail or mail-order copayment
Non-Preferred Brands: Retail or mail-order copayment

Contraceptive Devices (in California only) Prescription: $0 copayment

 

Non-Part D Diabetic Supplies You Pay
Lancets and Blood Sugar Diagnostics Prescription: $0 copayment
Glucometers Copayment or coinsurance per covered device

Medicare Coverage Gap Discount Program

If you are not receiving help to pay drug costs through the Low Income Subsidy (LIS) program or the Program of All-Inclusive Care for the Elderly (PACE), you qualify for the Medicare Coverage Gap Discount Program, which offers a discount on the cost of covered brand name prescription drugs. Once your 2019 prescription drug costs reach $3,820, the discount automatically kicks in on Medicare Part D-qualified brand name drugs until the cost paid by you and the discount reaches $5,000. The discount does not apply to Extra Covered Drugs.

Filling Prescriptions

In general, only prescriptions purchased through the in-network pharmacies listed below are covered. If you are unable to use a network pharmacy, you can request reimbursement from Anthem. For details, call Anthem Medicare Prescription Drug Member Services, toll free at (833) 279-0460, Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific).

At a Retail Pharmacy

You can fill up to a 30-day supply through Anthem’s national network of over 69,000 retail pharmacies, or at a UCMC pharmacy.

You can get up to a 90-day supply for the cost of two copayments at UC Friends pharmacies, including UCMC pharmacies, CVS (including inside Target stores), Walgreens, Safeway/Vons, and Costco.

UCMC Pharmacies

Prescription drug fills and refills are available at many UC Medical Center pharmacies.

Mail-Service Prescriptions

Get up to a 90-day supply of medication without leaving home. Use the Anthem mail service for maintenance medications, such as those taken on an ongoing basis to treat chronic conditions like asthma, diabetes, high blood pressure or high cholesterol. Home delivery makes it quick and convenient to fill. Start a new prescription and request refills online through Anthem (select Pharmacy), and your prescription is delivered to you by mail. Log on to Anthem.

Specialty Medication Prescriptions

For prescription drugs used to treat complex conditions, Anthem offers members access to a specialty pharmacy called Accredo, featuring 24-hour support from pharmacists and nurses, home delivery, and refill reminders so you never miss a dose.

Specialty prescription medications administered in your doctor's office (e.g., Botox) may be covered under your medical benefit (through CVS Specialty Pharmacy), not your prescription drug benefit. (CVS Specialty Pharmacy is different from the CVS retail pharmacy.) If you're having a specialty administered by your doctor, call Anthem Health Guide toll-free at (844) 437-0486 for information about actions you or your doctor need to take.

Money-Saving Options

Preferred Generics

Save money when you choose therapeutically equivalent generic equivalent medications over more expensive brand-name drugs. When your physician prescribes a brand name drug, ask if a generic equivalent is suitable for your condition. If a generic equivalent is available—and your doctor requests the brand-name instead—you’ll pay the cost of the generic drug plus the difference between the cost of the brand name drug and the generic equivalent.

Half Tablet

For medications that can be easily cut in half without compromising efficacy, you can save money by having your doctor write a prescription for double the strength (e.g., 20mg. vs. 10 mg). You’ll get the same dosage at half the out-of-pocket cost. Medications included in this program include Accupril, Crestor®, DiovanHCT®, Lexapro®, Losartan, Lovastatin, Paxil, Pravachol, Simvastatin, and Zoloft.

Specialty Split Fill

Many people stop taking newly prescribed specialty drugs (such as for oral oncology and iron toxicity) within the first 30 days of treatment because of side effects. This program gives you time to discover whether a certain class of drugs will work for you, without wasting money on unused medications or risking complications caused by discontinued use. Here’s how it works: When you receive a 30-day prescription, you’ll receive one 15-day supply at a prorated cost. This gives you two weeks to see how well you tolerate the drug or talk to your doctor about switching to a different medication.

Getting Help

Call Anthem Medicare Prescription Drug Member Services. They can answer questions about whether your prescription drug is covered, the cost of your copayment, or the location of the nearest pharmacy. Call them toll free at (833) 279-0460, available 24/7.

Anthem Health Guide provides support for medical and behavioral health services.