BlueAdvantage Plans will close at the end of 2022.

Health Plans For Colorado Federal Employees

BlueAdvantage HMO High Option

 

BlueAdvantage 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 BlueAdvantage HMO High Option:

 

You have to stay in network.

 

 

You’ll have predictable out-of-pocket costs.

 

 

There’s no annual deductible.

 

Learn More

Pharmacy Benefits For BlueAdvantage HMO High Option

 

Prescription Drug Copays For 2022

This table shows costs for prescription drugs in 2022. 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

$5 copay after calendar year deductible

$60

$10 copay

$40

Tier 2

$60 copay

$720

$150 copay

$600

Tier 3

$80 copay

$960

$200 copay

$800

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

$5 copay after calendar year deductible

Tier 2

$60 copay

Tier 3

$80 copay

Tier 4

25% of our allowance ($200 maximum per prescription)

Yearly Cost 30-Day Supply (Retail)

Tier 1

$60

Tier 2

$720

Tier 3

$960

Tier 4

-

90-day Supply (Mail Order)
 

Tier 1

$10 copay

Tier 2

$150 copay

Tier 3

$200 copay

Tier 4

90-day supply is not available

Yearly Cost 90-Day Supply (Mail Order)

Tier 1

$40

Tier 2

$600

Tier 3

$800

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

$15 copay

$180

N/A

N/A

Tier 2

$70 copay

$840

N/A

N/A

Tier 3

$90 copay

$1,080

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

$15 copay

Tier 2

$70 copay

Tier 3

$90 copay

* 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

$180

Tier 2

$840

Tier 3

$1,080

* 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

* 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

* 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.

BlueAdvantage HMO HDHP

 

BlueAdvantage 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 BlueAdvantage HMO HDHP:

 

You have to stay in network.

 

 

You don’t need a referral for in-network providers.

 

 

You can have a health savings account (HSA) to help pay out-of-pocket costs.

Pharmacy Benefits For BlueAdvantage HMO HDHP

 

Prescription Drug Copays For 2022

This table shows costs for prescription drugs in 2022. 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 after calendar year deductible

$120

$20 copay copay after calendar year deductible

$80

Tier 2

$20 copay after calendar year deductible

$480

$100 copay copay after calendar year deductible

$400

Tier 3

$80 copay after calendar year deductible

$840

$175 copay copay after calendar year deductible

$700

Tier 4

20% of our allowance after calendar year deductible ($300 maximum per prescription)

-

90-day supply is not available

90-day supply is not available

30-Day Supply (Retail)

Tier 1

$10 copay after calendar year deductible

Tier 2

$20 copay after calendar year deductible

Tier 3

$80 copay after calendar year deductible

Tier 4

20% of our allowance after calendar year deductible ($300 maximum per prescription)

Yearly Cost 30-Day Supply (Retail)

Tier 1

$120

Tier 2

$480

Tier 3

$840

Tier 4

-

90-day Supply (Mail Order)
 

Tier 1

$20 copay copay after calendar year deductible

Tier 2

$100 copay copay after calendar year deductible

Tier 3

$175 copay copay after calendar year deductible

Tier 4

90-day supply is not available

Yearly Cost 90-Day Supply (Mail Order)

Tier 1

$80

Tier 2

$400

Tier 3

$700

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

$15 copay after calendar year deductible

$180

N/A

N/A

Tier 2

$60 copay after calendar year deductible

$720

N/A

N/A

Tier 3

$90 copay after calendar year deductible

$1,080

N/A

N/A

Tier 4

25% of our allowance after calendar year deductible ($300 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

$15 copay after calendar year deductible

Tier 2

$60 copay after calendar year deductible

Tier 3

$90 copay after calendar year deductible

Tier 4

25% of our allowance after calendar year deductible ($300 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

$180

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.

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