Rx Negotiated Rates Anthem CA

[Guest]

Anthem CA Rx Negotiated Rates

Does anyone have an approximate idea of how far from retail Anthem negotiates on self injectable brand name Rx. I know there could be different rates for different Rx Providers. I’m just looking for an approximation based on what you may have seen in the past.

Thank You

 

[Dave020]

I came across something like this very recently, trying to determine whether to go with Health Net HSA or Blue Cross PPO on HIPAA (Shield was the same as Cross).

NFR on these is generally very little below the retail rate, maybe 10% if that.

 

[ABC]

For more detailed information call Anthem RX department.

Depending on what plan your selling if the insured orders through Anthem for a 90 day supply they get deeper discounts.

 

[Dave020]

For more detailed information call Anthem RX department.

Depending on what plan your selling if the insured orders through Anthem for a 90 day supply they get deeper discounts.

Anthem CA does not authorize 90 day fills on self injectibles. 30 days max dispensed at a participating pharmancy only.

Same with Blue Shield CA.

No mail order on self-injectibles.
- - - - - - - - - - - - - - - - - -

Does anyone have an approximate idea of how far from retail Anthem negotiates on self injectable brand name Rx. I know there could be different rates for different Rx Providers. I’m just looking for an approximation based on what you may have seen in the past.

Thank You

I'll save you some time here on the CA domestic side:

Anthem CA - 10% best discount over drugstore.com, 30-day supply only dispensed at a pharmacy, no mail order coverage (if they get it that way Anthem won't pay a dime), in formulary

Blue Shield CA - same as Anthem BC within a couple of dollars, same restrictions

Health Net CA - same restrictions although unless it's a basic med, most likely won't even be in their formulary, no non formulary brand coverage at all for self-injectibles no matter how it is dispensed.

 

[Guest]

Thanks for all the input. It seems like an H S A plan would be the most helpful type of coverage for a small group with an EE with an expensive medication like this.

 

[Dave020]

HSA can be a good fit for those with high Rx utilization. While they have the upfront NRF costs on the drugs, they make out ahead if they have other medical expenses inpatient and outpatient, as long as the drug is in the formulary.