Prescription Drug Benefits

What is the PPO Plan Prescription Benefit?
The plan has a $25 single and $50 annual deductible. Once you meet the deductible, then the plan pays 80% for Name Brand Prescriptions and 90% for Generic Prescriptions for all first time prescription purchases and for the next 2 refills. If the prescription is considered a maintenance prescription, this benefit will remain the same if you purchase future prescriptions through the mail order facility. If you buy maintenance drugs at a retail pharmacy, once the deductible is satisfied, the PPO Plan will pay 65% for Name Brand Prescriptions or 75% for Generic Prescriptions.
If your prescriptions are not considered maintenance, you will continue to receive the regular benefit at the retail pharmacy.
What is the Traditional Plan Prescription Benefit?
The plan has a $25 single and $50 annual deductible. Once you meet the deductible, then the plan pays 80% for prescriptions for all first time prescription purchases and for the next 2 refills. If the prescription is considered a maintenance prescription, this benefit will remain the same if you purchase future prescriptions through the mail order facility. If you buy maintenance drugs at a retail pharmacy, once the deductible is satisfied, the Traditional Plan will pay 65% for prescriptions.
If your prescriptions are not considered maintenance, you will continue to receive the regular benefit at the retail pharmacy.
How does using a mail order facility save money?
The lowest drug prices are available through mail order facilities when compared to retail pharmacy purchases. Consequently, both you and the Plan pay less for the drug when purchased through mail order.
What drugs are affected by the mail order requirement?
Only maintenance drugs are affected by this. Maintenance drugs, including birth control pills, are drugs taken for several months to treat chronic conditions or illnesses, such as allergies, diabetes, high blood pressure, heart disease, high cholesterol, asthma, pain management, attention deficit disorder, narcolepsy, hormone replacement, etc.
How will I know if I am taking maintenance drugs?
Any drug taken more than 3 months in a row will be considered a maintenance drug.
How soon can I start ordering by mail and saving money?
You may start the month after your initial fill at the pharmacy. Have your doctor provide you with a prescription written for your drug in a 90 day supply. Complete the anthem Rx Direct Prescription Order Form, attach your original prescription and mail to the address on the form.
When does the mail order requirement start for new prescriptions?
The first 30 day supply of each new prescription must be purchased at a retail pharmacy. You may purchase two extra 30 day refills at the pharmacy before the additional 15 percent charge is assessed.
What if I do not want to use a credit card or do not have one to use?
You can purchase by check or money order. Paying by check or money order, however, slows the process down. Realizing that drug prices are volatile and frequently change, you will be given an estimate when you request the price of a drug by phone. The actual price may have changed by the time your payment reaches Anthem. Your drugs will be shipped based on the estimate and you will be informed if you have a credit or debit balance when you receive your drugs. You need to make payment immediately to cover the debit balance and a credit balance can be carried over for the next refill. If you are utilizing the Flexible Spending Medical Plan, effective September 1, 2005, you can use your Benefit Card as the credit card to pay for your mail order prescriptions.
How do I find out the price of a drug?
To find out the price of a drug, call (800) 962-8192 and press 0 for customer service and request a price quote. You will need to give the customer service representative your ID#, the name of your drug, the strength of your prescription and the frequency for usage.
How do I refill mail order prescriptions?
Refill instructions will be included with your first 90 days of drugs. You can reorder by mail, on the internet at www.anthem.com or by calling (800) 962-8192. Please Note: Refills Will Not Be Done Automatically. You must contact mail order facility for refills just like you must contact the pharmacy today for a refill.
How soon can I order a refill after I receive my mail order prescription?
The instructions for refilling your prescription will tell you when you can
initiate the refill process. Typically, you can order your refill after you have
used 60 days of the 90 days supply sent to you.
What do I do if it seems my drugs are lost in the mail?
Call (800) 962-8192. They can track your order and send an
emergency supply of drugs, if necessary.
Can I use the internet to order my refill prescriptions?
Yes, just go to the Anthem website at www.anthem.com
What if I do not want to use the internet or the phone for mail order?
You can order by using US mail and the form available in the PEB office.
If you want to mail the form but not use a credit card, you need to go through the steps previously mentioned for getting a price estimate for the drug you
want to order.

Make your check payable to: Anthem Rx Direct.
Write your member ID on your check and mail it to:
Anthem Rx Direct
P.O. Box 746000
Cincinnati, OH 45274-6000
Who do I call at the University if I have other questions?
As usual with all benefit questions, contact the Office of Payroll and Employee Benefits at (765) 285-8461.