Prescriptions
Your prescription coverage.
Caltech’s pharmacy plan is a vital part of your medical benefits, designed to make managing your prescription needs simple and affordable. This section provides an overview of your options, including coverage for retail prescriptions, convenient mail-order prescriptions, and specialty medications. By exploring the differences, you’ll gain insights needed to choose the plan that best fits your needs and budget.
Mail Order
| Mail Order | ||||
|---|---|---|---|---|
| Anthem High Deductible PPO | Kaiser CA HMO | Anthem HMO | ||
| In Network Participating Providers (Up to 90-Day Supply) | Out of Network Non-Participating Providers (Up to 90-Day Supply) | Participating Providers (Up to 90-Day Supply) | Participating Providers (Up to 90-Day Supply) | |
| Preventive | Deductible waived | Not covered | No deductible | No deductible |
| Generic | $30 copay | Not covered | $30 copay | $30 copay |
| Brand-name formulary | $90 copay | Not covered | $100 copay | $90 copay |
| Brand-name non-formulary | $150 copay | Not covered | $100 copay | $150 copay |
| Non-Preventive | Deductible applies | Not covered | No deductible | No deductible |
| Generic | 20% coinsurance up to $200 per prescription, after deductible | Not covered | $30 copay | $30 copay |
| Brand-name formulary | 20% coinsurance up to $200 per prescription, after deductible | Not covered | $100 copay | $90 copay |
| Brand-name non-formulary | 20% coinsurance up to $200 per prescription, after deductible | Not covered | $100 copay | $150 copay |
Specialty Pharmacy
| Specialty Pharmacy | ||||
|---|---|---|---|---|
| Anthem High Deductible PPO | Kaiser CA HMO | Anthem HMO | ||
| Participating Providers (Up to 30-Day Supply) | Non-Participating Providers | N/A | Participating Providers (Up to 30-Day Supply) | |
| Specialty | $75 copay | Not covered | Not covered | $75 copay |
Retail Pharmacy
| Anthem High Deductible PPO | Kaiser CA HMO | Anthem HMO | ||
|---|---|---|---|---|
| Retail Pharmacy | ||||
| In Network Participating Providers (Up to 30-Day Supply) |
Out of Network* Non-Participating Providers (Up to 30-Day Supply) |
Participating Providers (Up to 30-Day Supply) |
||
| Preventive | Deductible waived | Deductible applies | No deductible | No deductible |
| Generic | $15 copay | 60% after deductible | $15 copay | $15 copay |
| Brand-name formulary | $45 copay | 60% after deductible | $50 copay | $50 copay |
| Brand-name non-formulary | $75 copay | 60% after deductible | $50 copay | $75 copay |
| Non-Preventive | Deductible applies | Deductible applies | No deductible | No deductible |
| Generic | 20% coinsurance up to $100 per prescription, after deductible | 60% after deductible | $15 copay | $15 copay |
| Brand-name formulary | 20% coinsurance up to $250 per prescription, after deductible | 60% after deductible | $50 copay | $50 copay |
| Brand-name non-formulary | 20% coinsurance up to $250 per prescription, after deductible | 60% after deductible | $50 copay | $75 copay |
* Out-of-network providers can still bill for costs not covered by insurance even after the out-of-pocket maximum is reached.
Medical Plan Provider: Anthem
Anthem is one of Caltech’s medical plan providers. Set up an account to view ID cards, track claims, check coverage, find in-network doctors, manage prescriptions, and utilize telehealth services.
Website: anthem.com/ca/Caltech
Download the mobile app:
Phone: (866) 820-0765 (M-F, 8 a.m.-12 a.m. PT)
Medical Plan Provider: Kaiser
Kaiser is one of Caltech’s medical plan providers. Set up an account to view ID cards, track claims, check coverage, find in-network doctors, manage prescriptions, and utilize telehealth services.
Website: choose.kaiserpermanente.org/caltech
Download the mobile app:
Phone: (800) 464-4000 (M-F, 8 a.m.- 6 p.m. PT)