Refill By Mail The Home Delivery Pharmacy sends drugs you take on a regular basis right to your door. And you get a larger supply of medicine for less money. 1 Your Prescription Drug [15-40-75 or 20%] Plan with Refill By Mail Your coinsurance Under your plan, for third-tier drugs you ll pay the greater of the third-tier copayment or 20 percent coinsurance with a $200 or $400 per-prescription maximum. There will also be a $3,500 per member per benefit year out-of-pocket maximum included with this benefit. See the chart below for how much you ll pay by drug tier category For medications you need when you are not in the hospital, you can receive Up to a 30-day medication supply from participating retail pharmacies First-tier Second-tier Third-tier [$15] [$40] [$75] Up to a 90-day medication supply delivered to your home [$15] [$80] [$225] What is Refill By Mail? Refill By Mail allows you to get up to three fills, depending on your plan, of a drug you take on a routine basis at your local pharmacy. After that, you ll need to order those drugs from the Home Delivery Pharmacy, managed by Express Scripts. If you decide to get them from your local pharmacy instead, you ll pay the full cost of the drugs. How does Refill By Mail work? You receive a letter and phone call reminding you the program is about to begin. Your first fill is covered at your local pharmacy. You receive a letter and phone call to let you know about ways to save with home delivery. Your second fill is covered at your local pharmacy. You receive a letter and phone call reminding you to choose home delivery so your prescription can be filled. Your third fill is covered only if you use the Home Delivery Pharmacy. What is the Home Delivery Pharmacy? Home delivery is a safe, easy way to get drugs you take on a regular basis for a long time. These types of drugs are used for conditions like asthma, heartburn, high blood pressure, allergies and high cholesterol. The Home Delivery Pharmacy is covered by your plan at no extra cost to you. Get more for less Refill By Mail saves you money because you must use the Home Delivery Pharmacy for most routine prescriptions. Many 90-day supplies cost the same as two 30-day supplies at a local pharmacy. That means you could save up to four copays a year on one drug. 1
Enjoy convenience Prescriptions are sent to your home using free, standard shipping within two weeks from the time the pharmacy receives your order. And you can get up to a 90-day supply of medicine, which means fewer refills and trips to the pharmacy. 1 Stay healthy The Home Delivery Pharmacy can help you stay current with your medicine and stay on top of your health. That helps reduce doctor and hospital visits. And registered pharmacists can answer your drug questions by phone any time. Get started with the Home Delivery Pharmacy It s simple. You can place your first order by mail or fax. Your order should arrive within 14 days of the date we receive your order. By mail: Visit anthem.com to get an order form. Log in and select Refill a Prescription. You will be directed to the Express Scripts website.² Click on Fill a New Prescription. Choose the Print a Prescription Order Form link. You can print the form and complete it by hand. Or you can fill out a webbased form and print it. Mail your completed form, prescription from your doctor, and payment to: Home Delivery Pharmacy PO Box 66785 St. Louis, MO 63166-6785 By fax: Have your doctor fax your prescription to 800-600-8105. It must be faxed directly from your doctor s office. If there is a question about your prescription, the pharmacy will contact your doctor. Questions about the Home Delivery Pharmacy? Call 866-281-4279 Order refills easily You can order refills by phone, mail or at anthem.com. Refills take about three to five days to process and ship. To make sure you have your medicine when you need it, the pharmacy can remind you to order refills. Or, you can even get automatic refills. By phone: Have your prescription label and credit card ready. You can order whenever you like. 24/7. Call 866-281-4279 and select Automated Refill Order Line from the menu. Or press zero any time to speak with a patient care advocate. If you are speech or hearing impaired, call 800-899-2114. Follow the prompts to place your order. By mail: Fill out an order form you received with a previous order. Affix your label or write your refill number in the space provided. Mail the form and your payment to: Home Delivery Pharmacy PO Box 66785 St. Louis, MO 63166-6785 Online: Visit anthem.com. Log in and select Refill a Prescription. You will be directed to the Express Scripts website.² Choose the drugs you want to refill, and click Add Refills to Cart. Review the order, shipping method, payment method, medical information and contact information, and make changes if needed. Click Place My Order.
Choose from a variety of payment options The pharmacy accepts many payment methods. Use the option that s best for you. You can pay with a check, money order, major credit card or debit card. 3 You can also use Bill Me Later, a service that lets you pay for your prescriptions over time. 4 Trust the safety of the Home Delivery Pharmacy The Home Delivery Pharmacy has a 99.99% accuracy rate, compared with a 98.3% accuracy rate at a local pharmacy. 5 That means you can be sure you re getting quality prescriptions. Here s how it works: Your prescription is received and reviewed. This review makes sure the drug is safe, based on your health and other drugs you may take. Once approved, it s filled by a licensed pharmacist. Your prescription goes through a series of automated and live checkpoints. This makes sure it s safe and accurate. Your order is packaged in a plain, tamper-proof pouch for your privacy and protection. If you take a drug that needs to be kept cold, it will be sent in a special cooling package. Your order is delivered free with standard shipping. Prescriptions can be sent overnight for a fee. 1 Plans vary. Check your plan for details and savings amounts. 2 The first time you re directed to the Express Scripts website, you ll go through a brief registration. The purpose is to set your preferences for communication and privacy. You ll do this only once. Please do not go directly to the Express Scripts website. The only way to make sure you re viewing your pharmacy information correctly is by logging in to anthem.com first. 3 More about using debit cards: When you place an order with a debit card, a hold will be placed on your card that is equal to the cost of your prescription. Your card will be charged once the order is filled, and the hold will be removed. For a short time, it may appear as if your card is being billed twice for your order, which is not the case. This situation may lead to your account being defined as overdrafted or overdrawn if the sum of the hold and the charge exceed the funds available in that specific account. Please check with the financial institution that manages your debit card for more information on how it handles this type of situation. 4 More about Bill Me Later: You can sign up for Bill Me Later in just seconds, and then take up to six months to make payments without interest on orders of $150 or more, as long as the balance is paid in full. Even if your order doesn t exceed $150, you can still use Bill Me Later. You simply pay for these purchases in full within the standard billing period to avoid any interest. You can also use your Bill Me Later account at more than 1,000 online stores, catalogs and travel partners. Visit billmelater.com for more information. Bill Me Later is subject to credit approval as determined by the lender, CIT Bank, Salt Lake City, Utah and is available to U.S. customers who are of legal age in their state of residence. The Bill Me Later account is governed by Utah and Federal Law and is available for web and phone orders. Visit www.express-scripts.com for important terms. 5 Express Scripts internal data, 2010 Specialty Pharmacy CuraScript, the Express Scripts specialty pharmacy, provides support and medicine for people with complex, long-term conditions. They include (but are not limited to): Asthma Bleeding disorders Cancer Crohn s disease Cystic fibrosis Grown hormone deficiency Hepatitis HIV/ADS Iron overload Multiple sclerosis Psoriasis Pulmonary arterial hypertension Rheumatoid arthritis Respiratory syncytial virus (RSV) Transplant CuraScript s CareLogic programs help people with the conditions listed above. These programs teach you about your condition and help you understand and cope with medication side effects. CareLogic nurses and pharmacists will schedule time with you to find out how you re doing. They also help you manage side effects of treatment. Call 888-773-7376, Monday through Friday, 8 a.m. to 9 p.m., Eastern time, to learn about how CareLogic can help you better manage your health condition. Nurses, pharmacists and patient care advocates work together to help improve your care. Their goal is to help you get the best results from your treatments.
Ordering specialty drugs You can place your first order by phone or fax: By phone: Call 800-870-6419, Monday through Friday, 8 a.m. to 9 p.m. and Saturday 9 a.m. to 1 p.m., Eastern time. A patient care advocate will help you get started. By fax: Ask your doctor to fax your prescription and ID card to 800-824-2642. Ordering specialty drug refills Online: visit anthem.com. Log in and select Refill a Prescription. You will be directed to the Express Scripts website. Choose the drugs you want to refill, and click Add refills to Cart. Review the order, shipping method, payment, medical information and contact information and make changes if needed. Click Place My Order. Note: For some drugs, you must call to order a refill. By phone: Have your member ID number and CuraScript prescription number ready. Call 800-870-6419, Monday through Friday, 8:00 a.m. to 9:00 p.m.; Saturday, 9:00 a.m. to 1:00 p.m., Eastern time, and select Place a Refill Order from the menu. Or press zero at any time to speak with a patient care advocate, If you are speech or hearing impaired, call 800-221-6915. Follow the prompts to place your order. Generic drugs If you re taking a brand name drug, you may save money by switching to an effective, lower-cost generic drug. Your plan covers brand and generic (or non-brand) drugs. When you choose a generic, your drug will work just as well as a brand drug but usually at a lower cost. Brand and generic drugs have the same active ingredient, strength and dose. And generics must meet the same high standards for safety, quality and purity. Prescription drugs will always be dispensed as ordered by your physician. If you or your doctor requests a brand name drug when a generic is available, you will pay your usual copayment for the generic drug plus the difference in the allowable charge between the generic and brand name drug. Why generics cost less Developing a new drug is expensive. When a company creates a new drug, it gets a patent for up to 20 years. That means only the company that created it can sell it during that time. Once the patent expires, other companies can make copies of the same drug. These companies avoid the high costs of developing the drug and that help lower the price for you. Talk to your doctor to see if a generic is right for you. Don t switch or stop taking any drugs until you talk to your doctor. Anthem Blue Cross and its HMO affiliate, HealthKeepers, Inc., receives financial credits from drug manufacturers based on total volume of the claims processed for their product utilized by Anthem Blue Cross and Blue Shield and Anthem HealthKeepers members. These credits are retained by Anthem Blue Cross and Blue Shield and HealthKeepers, Inc. as a part of its fee for administering the program for self-funded groups and used to help stabilize rates for fully-insured groups. Reimbursements to pharmacies are not affected by these credits. Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliated HMO, HealthKeepers, Inc., are independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. This benefits overview insert is only one piece of your entire enrollment package. See the enrollment brochure for a list of your plan s exclusions and limitations and applicable policy form numbers.
This summary of benefits has been updated to comply with federal and state requirements, including applicable provisions of the recently enacted federal health care reform laws. As we receive additional guidance and clarification on the new health care reform laws from the U.S. Department of Health and Human Services, Department of Labor and Internal Revenue Service, we may be required to make additional changes to this summary of benefits