Health Plans For California Federal Employees

Anthem Blue Cross Select HMO

 

Anthem Blue Cross Select HMO provides more of what you want – more choices, more convenience, and more control. That’s a lot of more, with Anthem as your dedicated, dependable partner on your healthcare journey.

 

 With Anthem Blue Cross Select HMO:

 

You have to stay in network.

 

 

You’ll have predictable out-of-pocket costs.

 

 

There’s no annual deductible.

 

Pharmacy Benefits

 

Prescription Drug Copays For 2022

This table shows your monthly and yearly costs for prescription drugs in 2022. If you have any questions about your coverage, call the Member Services number on the back of your identification card.

Level 1 Retail Pharmacies

Item

30-Day Supply (Retail) Yearly Cost 30-Day Supply (Retail) 90-day Supply (Mail Order) Yearly Cost 90-Day Supply (Mail Order)
Tier 1

$10 copay

$120

$25 copay

$100

Tier 2

$50 copay

$600

$110 copay

$440

Tier 3

$80 copay

$960

$170 copay

$680

Tier 4

25% of our allowance ($200 maximum per prescription)

-

90-day supply is not available

90-day supply is not available

Diabetic supplies

$10 copay

$120

$10 copay

$40

Compound drugs

$80 copay

$960

90-day supply is not available

90-day supply is not available

Level 2 Retail Pharmacies

Item

30-Day Supply (Retail) Yearly Cost 30-Day Supply (Retail) 90-day Supply (Mail Order) Yearly Cost 90-Day Supply (Mail Order)
Tier 1

$20 copay

$240

N/A

N/A

Tier 2

$60 copay

$720

N/A

N/A

Tier 3

$90 copay

$1,080

N/A

N/A

Diabetic supplies

$10 copay

$120

N/A

N/A

Compound drugs

$80 copay

$960

90-day supply is not available

90-day supply is not available

* Please note that pricing information is based on filling prescriptions at a Level 1 pharmacy. Add $10 to your copay if you’re having your prescriptions filled at a Level 2 pharmacy.