Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Albemarle |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Amelia |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Amherst |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Augusta |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Bedford |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Botetourt |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Campbell |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Clarke |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Culpeper |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Dinwiddie |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Fauquier |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Floyd |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Fluvanna |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Franklin |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Frederick |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Giles |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Greene |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Halifax |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Henry |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
King George |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Louisa |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Montgomery |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Orange |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Pittsylvania |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Prince Edward |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Prince George |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Pulaski |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Rappahannock |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Roanoke |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Rockbridge |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Rockingham |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Shenandoah |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Spotsylvania |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Stafford |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Tazewell |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Warren |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Washington |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Westmoreland |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Wise |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Wythe |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Alexandria City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Bristol City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Buena Vista City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Charlottesville City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Danville City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Falls Church City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Fredericksburg City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Harrisonburg City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Lexington City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Lynchburg City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Manassas City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Martinsville City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Roanoke City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Staunton City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Waynesboro City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Winchester City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Radford City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem MediBlue Essential (HMO) in VA - H3447-025-0
Benefit Details
|
Salem City |
$0.00 |
$150 Tier 1, 2, 3 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|