Health Plans For California Federal Employees
Anthem Blue Cross Select HMO
Anthem Blue Cross Select HMO provides more of what you want – more choices, more convenience, and more control. That’s a lot of more, with Anthem as your dedicated, dependable partner on your healthcare journey.
With Anthem Blue Cross Select HMO:
You have to stay in network.
You’ll have predictable out-of-pocket costs.
There’s no annual deductible.
Pharmacy Benefits
Prescription Drug Copays For 2025
This table shows your monthly and yearly costs for prescription drugs in 2025. If you have any questions about your coverage, call the Member Services number on the back of your identification card.
Level 1 Retail Pharmacies
|
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 |
$20 copay |
$80 |
|
Tier 2 |
$50 copay |
$600 |
$100 copay |
$400 |
|
Tier 3 |
$80 copay |
$960 |
$160 copay |
$680 |
|
Tier 4 |
25% of our allowance ($200 maximum per prescription) |
- |
90-day supply is not available |
90-day supply is not available |
30-Day Supply (Retail) |
|
|---|---|
|
Tier 1 |
$10 copay |
|
Tier 2 |
$50 copay |
|
Tier 3 |
$80 copay |
|
Tier 4 |
25% of our allowance ($200 maximum per prescription) |
Yearly Cost 30-Day Supply (Retail) |
|
|---|---|
|
Tier 1 |
$120 |
|
Tier 2 |
$600 |
|
Tier 3 |
$960 |
|
Tier 4 |
- |
90-day Supply (Mail Order) |
|
|---|---|
|
Tier 1 |
$20 copay |
|
Tier 2 |
$100 copay |
|
Tier 3 |
$160 copay |
|
Tier 4 |
90-day supply is not available |
Yearly Cost 90-Day Supply (Mail Order) |
|
|---|---|
|
Tier 1 |
$80 |
|
Tier 2 |
$400 |
|
Tier 3 |
$680 |
|
Tier 4 |
90-day supply is not available |
Level 2 Retail Pharmacies
|
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 |
N/A |
N/A |
|
Tier 2 |
$60 copay |
$720 |
N/A |
N/A |
|
Tier 3 |
$90 copay |
$1,080 |
N/A |
N/A |
|
Tier 4 |
25% of our allowance ($200 maximum per prescription) |
- |
N/A |
N/A |
|
* Please note that pricing information is based on filling prescriptions at a Level 1 pharmacy. Add $10 to your copay if you’re having your prescriptions filled at a Level 2 pharmacy. |
||||
30-Day Supply (Retail) |
|
|---|---|
|
Tier 1 |
$20 copay |
|
Tier 2 |
$60 copay |
|
Tier 3 |
$90 copay |
|
Tier 4 |
25% of our allowance ($200 maximum per prescription) |
|
* Please note that pricing information is based on filling prescriptions at a Level 1 pharmacy. Add $10 to your copay if you’re having your prescriptions filled at a Level 2 pharmacy. |
|
Yearly Cost 30-Day Supply (Retail) |
|
|---|---|
|
Tier 1 |
$240 |
|
Tier 2 |
$720 |
|
Tier 3 |
$1,080 |
|
Tier 4 |
- |
|
* Please note that pricing information is based on filling prescriptions at a Level 1 pharmacy. Add $10 to your copay if you’re having your prescriptions filled at a Level 2 pharmacy. |
|
90-day Supply (Mail Order) |
|
|---|---|
|
Tier 1 |
N/A |
|
Tier 2 |
N/A |
|
Tier 3 |
N/A |
|
Tier 4 |
N/A |
|
* Please note that pricing information is based on filling prescriptions at a Level 1 pharmacy. Add $10 to your copay if you’re having your prescriptions filled at a Level 2 pharmacy. |
|
Yearly Cost 90-Day Supply (Mail Order) |
|
|---|---|
|
Tier 1 |
N/A |
|
Tier 2 |
N/A |
|
Tier 3 |
N/A |
|
Tier 4 |
N/A |
|
* Please note that pricing information is based on filling prescriptions at a Level 1 pharmacy. Add $10 to your copay if you’re having your prescriptions filled at a Level 2 pharmacy. |
|