prescription drug coverage
The AmeriBen Blue Option PPO and AmeriBen Green Option Qualified HDHP include prescription coverage through Meritain/CVS Caremark.
The Kaiser Traditional HMO plan for California associates includes prescription drug coverage administered by Kaiser and provides convenient, cost-effective mail order services as well. See your summary of benefits for full details.
For Kaiser HMO for Hawaii associates or HMSA prescription coverage, please view the Hawaii associate benefits page.
Your prescription drug costs and coverage levels are based on the IMA medical plan you choose.
Associates enrolled in an AmeriBen plan can access a copy of the most current Formulary List at caremark.com. If you find that your medication is an excluded medication, you will need to speak with your physician to discuss other covered alternatives.
We have enhanced our prescription coverage on both the Blue Option PPO Plan and the Green Option Qualified High Deductible Health Plan to include select preventive medications at $0 cost to you and your family. Click below for a complete list of $0 cost preventive medicines:
Some strengths or dosage forms may not be included in the Preventive Therapy Drug List and certain products or categories may not be covered, regardless of their appearance in the documents above. Please check with your plan provider should you have any questions about coverage. Additional medications may be included in this list from time to time in compliance with Affordable Care Act requirements and/or U.S. Internal Revenue Service (IRS) guidance. This list includes medications considered preventive by the IRS; it may not include all preventive medications.
Prior Authorizations (PA) are designed to ensure that certain prescription drugs are used for appropriate medical purposes as approved by the Food and Drug Administration. This helps to make sure that your medications are safe, effective and more affordable.
When you’re prescribed certain medicines, your pharmacist may tell you it requires a PA. That means Meritain may need more information to make sure the prescribed medicine will work well for you and your condition, and that it’s covered by your pharmacy benefit. Your prescriber has access to the required information to complete the PA.
For more information on the PA process view the member document below. When you’re ready for your provider to submit a PA have your provider use the form below.
Participation in the copay assistance program is voluntary, however, to make it easier, you will be automatically enrolled. Please note that some specialty medications may require you to actively sign up to be eligible for the $0 copay. In this case, a PrudentRx Advocate will contact you to help you enroll. If you do not enroll, or if you choose to opt out of the program, you will be responsible for 30% of the cost of your specialty medications.
If you have any questions about the program, call PrudentRx at 1.888.203.1768, Monday through Friday, from 8am to 8pm EST.
Through Anthem, AmeriBen creates and publishes the Machine-Readable Files on behalf of IMA Financial Group, Inc. To link to the Machine-Readable Files, please click on the URL provided: https://www.anthem.com/machine-readable-file/search/
Lantern Care creates and publishes Machine-Readable Files on behalf of IMA Financial Group, Inc. To link to the Machine-Readable Files, please click on the URL provided: https://www.edhc.com/ProviderPricingTransparency/
