[ { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340170", "marketing_name" : "Anthem Silver Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PG", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 350, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 350.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 80, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 240.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 20, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 50.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340163", "marketing_name" : "Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81UF", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 525.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 190, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340252", "marketing_name" : "Anthem Silver Priority/Lean 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81VU", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 70, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 165.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340183", "marketing_name" : "Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81UP", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 250, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 250.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 37.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 60, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 180.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 30, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 90.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0530008", "marketing_name" : "Anthem Bronze Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81JE", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 500, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 500.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 100, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 300.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 50, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340151", "marketing_name" : "Anthem Silver Pathway/Lean 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PH", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 165.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 70, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340179", "marketing_name" : "Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81UP", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 250, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 250.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 30, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 90.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 60, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 180.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 37.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340256", "marketing_name" : "Anthem Bronze Priority/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81K4", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 100, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 300.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 50, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 500, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 500.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340212", "marketing_name" : "Anthem Bronze Priority/Lean HSA (+ Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81WH", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340187", "marketing_name" : "Anthem Bronze Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81WE", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 50, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 500, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 500.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 100, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 300.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340220", "marketing_name" : "Anthem Heart Healthy Bronze Priority/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PU", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 190, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 525.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340143", "marketing_name" : "Anthem Bronze Pathway/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81WD", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.7, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340232", "marketing_name" : "Anthem Silver Priority/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81WQ", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 20, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 50.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 80, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 240.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 350, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 350.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340111", "marketing_name" : "Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81UF", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 190, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 525.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340224", "marketing_name" : "Anthem Bronze Priority/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81K4", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 500, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 500.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 50, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 100, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 300.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340103", "marketing_name" : "Anthem Bronze Pathway/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81WD", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.7, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340159", "marketing_name" : "Anthem Gold Pathway/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81UX", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 65, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0530004", "marketing_name" : "Anthem Bronze Preferred/Broad HSA (+ Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81VB", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340181", "marketing_name" : "Anthem Silver Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PG", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 350, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 350.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 80, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 240.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 20, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 50.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340251", "marketing_name" : "Anthem Bronze Priority/Lean HSA (+ Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81WH", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340142", "marketing_name" : "Anthem Bronze Pathway/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81WD", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.7, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340186", "marketing_name" : "Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81UP", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 30, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 90.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 37.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 250, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 250.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 60, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 180.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0530009", "marketing_name" : "Anthem Silver Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81VC", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 80, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 240.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 350, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 350.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 20, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 50.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340150", "marketing_name" : "Anthem Silver Pathway/Lean 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PH", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 165.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 70, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340162", "marketing_name" : "Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81UF", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 525.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 190, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340255", "marketing_name" : "Anthem Silver Priority/Lean 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81JU", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 55, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 7.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340178", "marketing_name" : "Anthem Bronze Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81WE", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 500, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 500.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 50, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 100, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 300.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340134", "marketing_name" : "Anthem Bronze Pathway/Lean HSA (+ Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PR", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340223", "marketing_name" : "Anthem Silver Priority/Lean 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81JU", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 7.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 55, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340102", "marketing_name" : "Anthem Bronze Pathway/Lean HSA (+ Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PR", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340110", "marketing_name" : "Anthem Gold Pathway/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81UX", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 65, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340231", "marketing_name" : "Anthem Gold Priority/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86F9", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 30, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 90.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 60, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 180.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 37.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 250, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 250.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340215", "marketing_name" : "Anthem Silver Priority/Lean 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81VU", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 70, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 165.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340259", "marketing_name" : "Anthem Silver Priority/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81WQ", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 80, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 240.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 350, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 350.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 20, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 50.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340106", "marketing_name" : "Anthem Silver Pathway/Lean 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PH", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 70, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 165.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340227", "marketing_name" : "Anthem Bronze Priority/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81W4", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.7, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0530001", "marketing_name" : "Anthem Heart Healthy Bronze Preferred/Broad 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81PH", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 525.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 190, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340158", "marketing_name" : "Anthem Silver Pathway/Lean 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PD", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 7.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 55, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0530017", "marketing_name" : "Anthem Silver Preferred/Broad 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81T8", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 70, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 165.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340219", "marketing_name" : "Anthem Gold Priority/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81TT", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 65, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0530005", "marketing_name" : "Anthem Bronze Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81W0", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.7, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340160", "marketing_name" : "Anthem Gold Pathway/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81UX", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 65, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340180", "marketing_name" : "Anthem Silver Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PG", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 80, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 240.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 350, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 350.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 20, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 50.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340141", "marketing_name" : "Anthem Bronze Pathway/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81WD", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.7, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340230", "marketing_name" : "Anthem Gold Priority/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86F9", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 30, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 90.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 60, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 180.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 250, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 250.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 37.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340161", "marketing_name" : "Anthem Gold Pathway/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81UX", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 65, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340222", "marketing_name" : "Anthem Silver Priority/Lean 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81JU", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 7.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 55, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340157", "marketing_name" : "Anthem Silver Pathway/Lean 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PD", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 7.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 55, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340133", "marketing_name" : "Anthem Bronze Pathway/Lean HSA (+ Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PR", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340254", "marketing_name" : "Anthem Heart Healthy Bronze Priority/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PU", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 525.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 190, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340226", "marketing_name" : "Anthem Bronze Priority/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81W4", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.7, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340169", "marketing_name" : "Anthem Bronze Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81WE", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 500, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 500.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 100, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 300.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 50, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0530010", "marketing_name" : "Anthem Gold Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81W8", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 30, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 90.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 37.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 60, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 180.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 250, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 250.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340258", "marketing_name" : "Anthem Gold Priority/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86F9", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 37.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 30, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 90.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 250, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 250.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 60, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 180.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340214", "marketing_name" : "Anthem Silver Priority/Lean 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81VU", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 165.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 70, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340109", "marketing_name" : "Anthem Silver Pathway/Lean 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PD", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 55, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 7.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0530006", "marketing_name" : "Anthem Silver Preferred/Broad 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81UE", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 7.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 55, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340218", "marketing_name" : "Anthem Gold Priority/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81TT", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 65, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340171", "marketing_name" : "Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81UP", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 60, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 180.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 37.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 30, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 90.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 250, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 250.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340152", "marketing_name" : "Anthem Silver Pathway/Lean 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PH", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 165.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 70, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340164", "marketing_name" : "Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81UF", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 190, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 525.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340184", "marketing_name" : "Anthem Silver Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PG", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 80, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 240.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 20, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 50.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 350, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 350.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0530007", "marketing_name" : "Anthem Gold Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86FH", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 65, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340233", "marketing_name" : "Anthem Silver Priority/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81WQ", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 350, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 350.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 80, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 240.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 20, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 50.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340156", "marketing_name" : "Anthem Silver Pathway/Lean 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PD", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 15, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 7.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 120.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 55, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340132", "marketing_name" : "Anthem Bronze Pathway/Lean HSA (+ Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PR", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340253", "marketing_name" : "Anthem Gold Priority/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81TT", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 65, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.65, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.6, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340188", "marketing_name" : "Anthem Bronze Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81WE", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 500, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 500.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 100, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 300.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 50, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340221", "marketing_name" : "Anthem Heart Healthy Bronze Priority/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd86PU", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 525.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 190, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 40, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340257", "marketing_name" : "Anthem Bronze Priority/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81W4", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.4, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.5, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 25.00, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.7, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.45, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 0.55, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340213", "marketing_name" : "Anthem Bronze Priority/Lean HSA (+ Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81WH", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 0, "copayOpt" : null, "coinsuranceRate" : 1.0, "coinsuranceOpt" : "AFTER DEDUCTIBLE" } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] }, { "plan_id_type" : "HIOS-PLAN-ID", "plan_id" : "79475WI0340225", "marketing_name" : "Anthem Bronze Priority/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)", "summary_url" : "http://www.sbc.anthem.com/dps/ccd81K4", "plan_contact" : "JSON-DeliverySupport@elevancehealth.com", "network" : [ { "network_tier" : "PARTICIPATING" } ], "formulary" : [ { "drug_tier" : "TIER-THREE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 100, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 300.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-FOUR", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 500, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 500.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-TWO", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 50, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 150.00, "copayOpt" : "AFTER DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] }, { "drug_tier" : "TIER-ONE", "mail_order" : true, "costSharing" : [ { "pharmacyType" : "1-MONTH-IN-RETAIL", "copayAmount" : 25, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null }, { "pharmacyType" : "3-MONTH-IN-MAIL", "copayAmount" : 62.50, "copayOpt" : "NO DEDUCTIBLE", "coinsuranceRate" : 0.0, "coinsuranceOpt" : null } ] } ], "last_updated_on" : "2025-07-12", "years" : [ 2025 ] } ]