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When You Need a Prescription
When you enroll in a LAPRA medical plan, you automatically receive prescription drug coverage as shown in
the table below. Note that prescription drugs count towards your medical plan calendar year out-of-pocket
maximum in the Anthem Blue Cross CaliforniaCare Plus HMO and the Kaiser HMO, but there is a separate
prescription drug out-of-pocket maximum for the Anthem Blue Cross Prudent Buyer PPO.
To save money on prescription drugs, request that your doctor write your prescriptions for “generic” drugs
whenever possible. Generic drugs are often the therapeutic equivalent of their brand-name counterparts, but
cost significantly less.
You can purchase up to a 90-day supply of most maintenance drugs at a retail pharmacy under the Anthem
Blue Cross Prudent Buyer PPO and CaliforniaCare Plus HMO. Maintenance drugs are those used to treat chronic
conditions and are typically taken on a regular basis. Also, women’s prescription contraceptives will be covered
with a $0 co-pay under any LAPRA medical plan option to comply with requirements of the Affordable Care Act.
Prescription Drugs
Anthem Blue Cross
Prudent Buyer PPO
Anthem Blue Cross
CaliforniaCare Plus HMO
(California Residents Only)
Kaiser
HMO
(California Residents Only)
Calendar Year
Prescription Drug
Out-of-Pocket Maximum
$4,850 per person
$7,700 per family
(not to exceed $4,850
for any one person)
N/A
N/A
Retail Pharmacy
• Generic
1
• Brand
• Maintenance Drugs
• Injectables
2
• Retail Supply
$15 co-pay
$25 co-pay
2 co-pays (90-day supply)
20% co-pay,
1
max
$150/prescription
Up to 30 days (90 days for
maintenance drugs
3
)
$15 co-pay
$25 co-pay
2 co-pays (90-day supply)
20% co-pay,
1
max
$150/prescription
Up to 30 days (90 days for
maintenance drugs
3
)
$15 co-pay
$30 co-pay
n/a
n/a
Up to 30 days
Mail Order
• Generic
1
• Brand
• Injectables
2
• Mail Order Supply
1-30 day supply / 31-90 day supply
$15 co-pay / $30 co-pay
$25 co-pay / $50 co-pay
20% co-pay, max 20% co-pay, max
$150/prescription $300/prescription
Up to 90 days
1-30 day supply / 31-90 day supply
$15 co-pay / $30 co-pay
$25 co-pay / $50 co-pay
20% co-pay, max 20% co-pay, max
$150/prescription $300/prescription
Up to 90 days
1-30 day supply / 31-100 day supply
$15 co-pay / $30 co-pay
$30 co-pay / $60 co-pay
n/a
Up to 100 days
1
$0 co-pay for women’s prescription contraceptives.
2
20% co-pay does not apply to insulin. Regular co-pays apply.
3
Maintenance drugs are those used to treat chronic conditions and are typically taken on a regular basis. To determine if your medication qualifies
as a maintenance drug, contact Anthem Blue Cross at 800-700-2541. Maintenance drugs do not include any controlled substances, smoking
cessation or weight management medications.
Click herefor the LAPRA 2017-2018 Medical &
Dental monthly premium rates. An insert is also
included in your enrollment packet.