Medical Plan

Prescription Drug Coverage

Each medical plan provides prescription drug coverage. The amount you pay depends on the plan you select. Benefit Tip: The Anthem Blue Cross Silver and Bronze plans both provide 100% coverage for preventive medications (most blood pressure medications, for example). Click here for a list of preventive medications.

	Anthem Blue Cross Gold Plan	Anthem Blue Cross Silver Plan	Anthem Blue Cross Bronze Plan	Kaiser Permanente†
	You Pay	You Pay	You Pay	You Pay
Pharmacy Retail RX (up to 30-day supply)
Preventive	N/A	$0	$0	N/A
Generic	$10	$10*	$10*	$10
Preferred Brand	$30	20%: $25 min.*/$50 max.	30%: $25 min.*/$50 max.	$35
Non-Preferred Brand	$50	20%: $50 min.*/$100 max.	30%: $50 min.*/$100 max.	N/A
Specialty - Non PrudentRX	$50	20%: $75 min.*/$200 max.	30%: $75 min.*/$200 max.	N/A
Specialty - PrudentRX	$0 cost of share to member if enrolled. If not enrolled 30% coinsurance‡	20%: $75 min.*/$200 max.	30%: $75 min.*/$200 max.	N/A
Mail Order RX (up to 90-day supply)
Preventive	N/A	$0	$0	N/A
Generic	$20	$20*	$20*	$20
Preferred Brand	$60	20%: $65 min.*/$125 max.	30%: $65 min.*/$125 max.	$70
Non-Preferred Brand	$100	20%: $125 min.*/$250 max.	30%: $125 min.*/$250 max.	N/A
Specialty - Non PrudentRX	$50	20%: $75 min.*/$200 max.	30%: $75 min.*/$200 max.	N/A
Specialty - PrudentRX	$0 cost of share to member if enrolled. If not enrolled 30% coinsurance‡	20%: $75 min.*/$200 max.	30%: $75 min.*/$200 max.	N/A

*Copay/cost share applies after plan deductible is met.
**If the actual cost of the drug is less than the minimum, you pay the cost of the drug.
†Available to employees in the following states only: California, Colorado, Mid Atlantic, Georgia, Northwest and Washington.
‡ The PrudentRx Copay Program allows you to get any of your covered specialty medications that are on your Plan's Exclusive Specialty Drug list for $0 out-of-pocket when you fill at CVS Specialty. Must be enrolled. Call PrudentRx 800-578-4403.