Prescription Drug Changes

Effective July 1, 2017 a specialty drug copay of $100 was introduced to the plan

  • What is a "Specialty Drug"? These are high cost prescription medications used to treat complex, chronic conditions like cancer, rheumatoid arthritis, and multiple sclerosis. They often require special handling (like refrigeration ) and administration (such as injection or infusion.)

Due to the rising costs of specialty drugs, a $100 copay with a 30-day supply limit was added to engage members to educate themselves about pricing transparency and escalating prescription drug costs.

Important Reminders

Prior to the move to Anthem, our Medical Mutual plan also had the following programs in place (1):

  • Prior Authorization: A requirement that your physician obtain approval from the health plan to determine if certain medications will be covered based upon established criteria.
  • Step Therapy: A requirement that you first try a less expensive drug for certain medications proven to be effective for most people before progressing to other, more costly or risky therapies, only if necessary.
  • Quantity Limits: When the amount of a particular drug is restricted, usually for safety and cost reasons.

(1) If you believe one of these programs is being incorrectly applied to one or more of your prescriptions, please contact your prescribing physician and request they work directly with Anthem to resolve any issues.

Please Note: This is informational in nature. It is not medical advice. You should contact your physician with any questions.

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