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Prescription Drug Plan

The Select and Choice PPO plans offer two ways to save money on prescription drugs - through retail pharmacies and the mail order service. Both are administered by PharmaCare Management Service, Inc. .

Retail Pharmacy Benefits

You can get your prescription filled at any pharmacy participating in the PharmaCare pharmacy network. The PharmaCare network includes many independent pharmacies and most major pharmacy chains. The plan pays covered prescriptions at 100% after you pay the applicable co-payment. Your co-payment will depend on the type of prescription drug you receive - generic, preferred brand name or non-preferred brand name prescription drugs. What are generic, preferred and non-preferred brand name drugs? Click here for a description.

Prescription Drug Plan - CVS CAREMARK - Managed Pharmacy (h)(k)

Retail Pharmacy -
Up to 30-day Supply

CVS Caremark Pharmacy

Out of Network Pharmacy

1.

Generic Drugs - Generics required, see below

$12 copay per prescription

If you use a non-participating Pharmacy, you will pay 100% of the prescription cost at the time of purchase. You must then file a paper claim form along with the original prescription receipt to CVS CAREMARK for covered medications. The out of network Pharmacy cost will be paid at the same amounts as an in network Pharmacy. The Plan Participant pays the difference.

2.

Diabetic Medications (i)

$12 copay per prescription

3.

Prescription Birth Control

Prescription birth control is covered at 100% with no copay or coinsurance.

4.

Preferred Brand - Retail

20% copay per prescription, $20 minimum and a $70 maximum

5.

Non-Preferred Brand - Retail

35% copay per prescription, $40 minimum and a $90 maximum

Retail Pharmacy –
Up to 90 Day Supply

Tuality 7th Ave Medicine Shoppe only

 

1.

Generic Drugs - Generics required see below

$35 copay per prescription

Not Covered.
Must use 7th Ave Tuality Medicine Shoppe

2.

Diabetic Medications (i)

$35 copay per prescription

3.

Prescription Birth Control

Prescription birth control is covered at 100% with no copay or coinsurance

4.

Preferred Brand - Retail

$75 copay per prescription

5.

Non-Preferred Brand - Retail

$115 copay per prescription

Mail Order Pharmacy -
Up to 90 Day Supply

CVS Caremark Mail Order Pharmacy Only

 

1.

Generic Drugs – Generics required, see below (j)

$30 copay per prescription

Not covered. Must use CVS CAREMARK mail order

2.

Diabetic Medications (i)(j)

$30 copay per prescription

3.

Prescription Birth Control

Prescription birth control is covered at 100% with no copay or coinsurance

4.

Preferred Brand (j)

$60 copay per prescription

5.

Non-Preferred Brand (j)

$100 copay per prescription

Plan Provisions

 

Pharmacy out-of-pocket
Maximum

$2,000 per individual - combined In-Network and Out of Network Prescription Drugs. Excludes cost containment penalties.

Generics Required

All prescriptions filled under the retail or mail order Prescription Drug program will be automatically filled with the generic version of the medication (if one is available). Otherwise, you will be charged the difference in the price between the brand-name and generic version of that medication, plus the generic copay. A listing of preferred brand drugs can be obtained from CVS Caremark

(h) Some Prescription Drug medications require preauthorization or they may have internal plan limits. Please contact CVS CAREMARK regarding any limits or restrictions to the Prescription Drug program.

(i) Diabetic medications and supplies covered at the level 1 copay including insulin replacement and oral diabetic medications, syringes, pen needles, test strips and lancets.

(j) By law, CVS CAREMARK must fill your prescription for the exact quantity of medication prescribed by your health care provider, up to the 90-day plan limit. "30 days plus 2 refills" does not equal one prescription written for "90 days." Be sure your health care provider writes the prescription accurately.

(k) Contact Caremark Connect program for high cost Specialty medications at 1-800-237-2767

Definition of Drugs - What are generic, preferred, and non-preferred drugs?

Generic Drugs

Generic drugs have brand name equivalents but are significantly less expensive than the brand name.To be sure you pay the lowest co-payment, ask your doctor to prescribe generic medications, when appropriate.

Preferred Drugs

Preferred Prescription Drugs are brand name drugs that are effective for treating specific condition and are more cost-effective than equivalent non-preferred drugs. Often there is a choice of medications you can take for the same condition. One or more of these medications may be a preferred drug under this plan.

Non-Preferred Drugs

Non-Preferred Drugs are brand name drugs that are less cost-effective than preferred brand name drugs, but not more therapeutically effective than preferred brand name or generic drugs. Non-preferred drugs require a higher co-payment. Depending on your personal health care needs, there may be times when non-preferred drugs are right for you. In these situations, you will need to pay the non-preferred co-payment.

Mandatory Generic Requirement: All prescriptions filled under the retail or mail order prescription drug program will be automatically filled with the generic version of medication (if one is available). Otherwise, you will be charged the difference in the price between the brand-name and generic version of that medication, pus the generic copay.

THE LISTING OF PREFERRED BRAND DRUGS CAN BE OBTAINED BY CONTACTING CVS CAREMARK.

Important note: You will pay the non-preferred drug co-payment if a generic or preferred brand name drug is not available.