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California Plan Benefits

Anthem Blue Cross Select HMO

With Anthem Blue Cross Select HMO, you get more of what you want - more choices, more convenience and more control. That's a lot of more. And with Anthem, you get a dedicated, dependable partner to join you on your journey.

Learn more about the Anthem Blue Cross Select HMO

Let's break down some more details of the Anthem Blue Cross Select HMO.

  • You have to stay in network
  • You'll have predictable out-of-pocket costs
  • There's no annual deductible

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Pharmacy Benefits

Prescription Drug Copays for 2021

This table shows your monthly and yearly costs for prescription drugs in 2021. If you have any questions about your coverage, call the Member Services number on the back of your identification card.

Level 1

30-Day Supply (Retail) Yearly Cost 30-Day Supply (Retail) 90-day Supply (Mail Order) Yearly Cost 90-Day Supply (Mail Order)
Tier 1 $10 copay $120.00 $25 copay $100.00
Tier 2 $50 copay $600.00 $110 copay $440.00
Tier 3 $80 copay $960.00 $170 copay $680.00
Tier 4 25% of our allowance
($200 maximum per prescription)
90-day supply is not available 90-day supply is not available
Diabetic supplies $10 copay $120.00 $10 copay $40.00
Compound drugs $80 copay $960.00 90-day supply is not available 90-day supply is not available
Prescription Drug Copays for 2020 at Level Two

Level 2

30-Day Supply (Retail) Yearly Cost 30-Day Supply (Retail) 90-day Supply (Mail Order) Yearly Cost 90-Day Supply (Mail Order)
Tier 1 $20 copay $240.00 N/A N/A
Tier 2 $60 copay $720.00 N/A N/A
Tier 3 $90 copay $1,080.00 N/A N/A
Tier 4 25% of our allowance
($200 maximum per prescription)
90-day supply is not available 90-day supply is not available
Diabetic supplies $10 copay $120.00 N/A N/A
Compound drugs $80 copay $960.00 90-day supply is not available 90-day supply is not available

Level 1

Level 2

Benefits Resources