Prescription Drug Coverage

When you enroll in a Capital One medical plan, you’re also automatically enrolled in prescription drug coverage through CVS Caremark—coverage is the same for all three medical plans. Your CVS Caremark information can be found on your Anthem Blue Cross Blue Shield ID card.

The addition of Pharmacy Advisor Counseling will provide support for patients in CVS stores. The service offers confidential advice, medication information, tips to help manage or avoid medication side effects and additional guidance. Also, additional controls may apply for certain high-cost medications and specialty medications. These controls include prior authorizations and requirements to try certain lower cost medications first.

Prescription Filling Options

Through the prescription program, you may fill prescriptions:

  • At a participating pharmacy for up to a 30-day supply. When you do, you pay set amount, based on the drug tier of the prescription.
  • Through CVS Caremark’s mail-order pharmacy for a 90-day supply. Using the Maintenance Choice program will save you money and provide the convenience of having maintenance medication mailed directly to your home or address of your choosing. Or, you can elect to have your maintenance medications dispensed in a 90-day supply at a CVS pharmacy. CVS can work with you on payment options for your medications. Please contact CVS Caremark at 1-877-210-3556 or log in to caremark.com for more information regarding signing up for these programs.
  • A note on Specialty Medications: Certain medications are filled only through CVS Caremark’s specialty pharmacy. Please contact CVS Caremark at 1-877-210-3556 or log in to caremark.com for more information.
  • At the Knolls, Plano and West Creek Health Centers and Pharmacies. The Knolls, Plano and West Creek Health Centers offer a pharmacy for short-term medications (like antibiotics), 90-day supply for maintenance medications and a limited selection of over-the-counter medications. See Pulse for more information.
Prescription Costs

Your prescription cost reflects the type of medication that is used and the way you fill your prescription:

Type of Drug/Program Cost You Pay
Retail
(up to a 30-day supply)		 Mail order or CVS
(up to a 90-day supply)
Generic $10 co-pay $20 co-pay
Preferred Brand $50 co-pay $100 co-pay
Non-Preferred Brand $100 co-pay $200 co-pay
Specialty

The Specialty Pharmacy program is designed to provide associates who routinely take medications for certain conditions with access to the best discounts and highest quality of medication available. Medication for these conditions can be purchased only through the CVS Caremark Specialty Program - no part of the cost is covered by the plan if purchased from a retail pharmacy.

30-day supply

  • Generic: $40
  • Preferred Brand: $100
  • Non-Preferred Brand: $200
Be Well Pharmacy Discount Program

Available to patients with certain chronic conditions who work with Anthem nurses. Available for mail order prescriptions only:

  • Generic—$0
  • Preferred brand—$20
  • Non-preferred brand—$100

Note: Some prescriptions must meet defined criteria before they are covered by the plan.

PREFERRED DRUG LIST

A preferred drug list is a formulary list of drugs the plan has determined to be reasonable in cost and effective for treatment. A non-formulary drug also is effective for treatment, but isn’t as cost-effective as a formulary or generic drug. A group of practicing physicians and pharmacists routinely reviews drugs to include in a formulary. If clinical data shows several drugs are equally effective, the most cost-effective drug is usually chosen. The formulary may change from time to time. You can view CVS Caremark’s formulary at caremark.com.

Be Well Pharmacy Discount Program

You and your enrolled dependents may be eligible to receive reduced costs for the prescription drugs that help manage certain chronic conditions, including diabetes, hypertension, high cholesterol, asthma/COPD or congestive heart failure. Call an Anthem Nurse to qualify for the discount at 1-844-390-4133, press option 4 to speak with a nurse Monday through Friday from 8 a.m. to 11 p.m. ET.

PARTICIPATING PHARMACIES

CVS Caremark provides a broad selection of participating retail chains, including Giant, Walgreens, Walmart and many independent pharmacies, in addition to CVS pharmacies.These pharmacies can be used for all short-term medications—generally those taken less than 60 days or two fills at retail. For all maintenance medications (those taken ongoing—generally longer than 60 days or after two fills at retail), you must have those filled as a 90-day supply either at your local CVS or via CVS Caremark’s mail-order program (90-day supplies can also be filled at our Health Center Pharmacies at Knolls, Plano and West Creek). To find out if a pharmacy is part of the plan's network, check CVS Caremark’s website (caremark.com) or call 1-877-210-3556.

USE GENERIC

You can save money with generic prescriptions, which are chemically and therapeutically equivalent to their brand-name counterparts but generally cost between 20% and 70% less. If you request that a brand-name prescription be filled as written, even though it has a generic equivalent available, you'll pay the brand cost share under the plan and the difference between the brand and the generic equivalent.

BRAND NAMES CAN COST
YOU MORE

When your doctor notes your prescription as “Dispense as Written” or “DAW”—indicating that a brand must be dispensed, and there is a generic available—the pharmacist will automatically dispense a generic equivalent. You have the option to request the brand version, but you’ll pay the difference between the brand and the generic equivalent (in addition to the brand co-pay under the plan).

CHECK THE CVS CAREMARK FORMULARY

The formulary is a list of preferred drugs that includes both preferred, non-preferred and generic drugs. The prescription drug benefits pay at different levels, depending upon the type of drug. If you use a generic drug or a preferred drug on the formulary, your cost will be less than if you use a non-preferred medication that does not appear on the formulary list. You can find the CVS Caremark formulary online at www.caremark.com.