Question: I recently switched carriers from Blue Shield to Anthem Blue Cross because of better provider network in my area. However now I am sorry I did. Anthem’s pre-purchase benefit description for the Silver 70 Plan plainly states that generic prescriptions have a $15 copay with no deductible. When I tried to fill the prescription for my medication, I am now told that it is a “tier 4” Generic and is subject to a $200 plus deductible and has a 20% coinsurance. I feel quite mislead by their false advertising. I had Blue Shield up to last month and they had a flat $15 copay for generics with no ded, as advertised. I would like to request a special enrollment to switch back to Blue Shield, I feel they are a much more honest and dependable carrier that takes care of their customers. Would this be possible or am I locked in for the rest of the year?
Answer: While I can’t guarantee it, i feel quite certain Covered California will grant you SEP eligibility and allow you to change health plans. You should check the formulary and confirm that the drug is still considered Tier 1 with Blue Shield before going to the trouble of switching. There are variances among the carrier’s drug lists. Each carrier maintains a searchable drug-formulary list on their consumer websites. It is not uncommon for one particular prescription drug to be considered Tier 1 with one carrier and Non-Preferred with another so, all relevant prescription drugs should be researched before making a decision.