Prescriptions
Your prescription coverage.
The pharmacy plan is a vital part of your medical benefits, designed to make managing your prescription needs simple and affordable.
Retail Pharmacy
| Retail Pharmacy | ||||
|---|---|---|---|---|
| Anthem High Deductible PPO | Kaiser CA HMO | Anthem HMO | ||
| In Network Participating Providers (Up to 30-Day Supply) |
Out of Network* Non-Participating Providers (Up to 30-Day Supply) |
Participating Providers (Up to 30-Day Supply) |
||
| Preventive | Deductible waived | Deductible applies | No deductible | No deductible |
| Generic | $15 copay | 60% after deductible | $15 copay | $15 copay |
| Brand-name formulary | $45 copay | 60% after deductible | $50 copay | $50 copay |
| Brand-name non-formulary | $75 copay | 60% after deductible | $50 copay | $75 copay |
| Non-Preventive | Deductible applies | Deductible applies | No deductible | No deductible |
| Generic | 20% coinsurance up to $100 per prescription, after deductible | 60% after deductible | $15 copay | $15 copay |
| Brand-name formulary | 20% coinsurance up to $250 per prescription, after deductible | 60% after deductible | $50 copay | $50 copay |
| Brand-name non-formulary | 20% coinsurance up to $250 per prescription, after deductible | 60% after deductible | $50 copay | $75 copay |
* Out-of-network providers can still bill for costs not covered by insurance even after the out-of-pocket maximum is reached.
Mail Order
| Mail Order | ||||
|---|---|---|---|---|
| Anthem High Deductible PPO | Kaiser CA HMO | Anthem HMO | ||
| In Network Participating Providers (Up to 90-Day Supply) | Out of Network Non-Participating Providers (Up to 90-Day Supply) | Participating Providers (Up to 90-Day Supply) | Participating Providers (Up to 90-Day Supply) | |
| Preventive | Deductible waived | Not covered | No deductible | No deductible |
| Generic | $30 copay | Not covered | $30 copay | $30 copay |
| Brand-name formulary | $90 copay | Not covered | $100 copay | $90 copay |
| Brand-name non-formulary | $150 copay | Not covered | $100 copay | $150 copay |
| Non-Preventive | Deductible applies | Not covered | No deductible | No deductible |
| Generic | 20% coinsurance up to $200 per prescription, after deductible | Not covered | $30 copay | $30 copay |
| Brand-name formulary | 20% coinsurance up to $500 per prescription, after deductible | Not covered | $100 copay | $90 copay |
| Brand-name non-formulary | 20% coinsurance up to $500 per prescription, after deductible | Not covered | $100 copay | $150 copay |
Specialty Pharmacy
| Specialty Pharmacy | ||||
|---|---|---|---|---|
| Anthem High Deductible PPO | Kaiser CA HMO | Anthem HMO | ||
| Participating Providers (Up to 30-Day Supply) | Non-Participating Providers | Participating Providers (Up to 30-Day Supply) | Participating Providers (Up to 30-Day Supply) | |
| Specialty | $75 copay | Not covered | $50 copay | $75 copay |
Medical Plan Provider: Anthem
Anthem is one of Caltech’s medical plan providers. Set up an account to view ID cards, track claims, check coverage, find in-network doctors, manage prescriptions, and utilize telehealth services.
Website: anthem.com/ca/Caltech
Download the mobile app:
Phone: (866) 820-0765 (M-F, 8 a.m.-12 a.m. PT)
Medical Plan Provider: Kaiser
Kaiser is one of Caltech’s medical plan providers. Set up an account to view ID cards, track claims, check coverage, find in-network doctors, manage prescriptions, and utilize telehealth services.
Website: choose.kaiserpermanente.org/caltech
Download the mobile app:
Phone: (800) 464-4000 (M-F, 8 a.m.- 6 p.m. PT)