| Plan Features | Anthem Gold PPO Plan | |
|---|---|---|
| In-Network | Out-of-Network | |
| Annual Out-of-Pocket Maximum* Individual/Family | $2,000/person | $2,000/person |
| Prescription Drugs: Retail (up to a 30-day supply) | ||
| Maintenance (Generic) | $5 | $20 |
| Generic | $10 | $20 |
| Preferred Brand | $20 | $40 |
| Non-Preferred Brand | $40 | $80 |
| Specialty (30-day supply) | $0 if enrolled in the PrudentRx Copay Program. 30% coinsurance if not enrolled in the program. | |
| Prescription Drugs: Mail Order (up to a 90-day supply) | ||
| Maintenance (Generic) | $10 | N/A |
| Generic | $20 | |
| Preferred Brand | $40 | |
| Non-Preferred Brand | $80 | |
*Separate from medical plan out-of-pocket maximum.
By enrolling in PrudentRx, you will pay $0 for your specialty medication, if included in the specialty medication list. If you do not enroll, you’ll pay 30% of the medication cost.
| 1 | 2 | 3 | 4 |
|---|---|---|---|
| Review the Specialty Drug List. | Call PrudentRx at 800-578-4403. | Enroll in the PrudentRx program. | Pay $0 for specialty medications! |
Note: Pre-certification is required, and prescriptions must be filled through CVS Specialty Pharmacy.
(8 a.m. – 8 p.m. ET)