Prescription - CVS Health
CVS Health administers prescription drug benefits for all health plans. This prescription drug benefit allows you to obtain covered prescription drugs and diabetic supplies at a retail pharmacy or through a CVS Health Mail Service pharmacy. Mail Service or CVS pharmacy pickup is required after two retail refills for all maintenance/lifetime medications.
To receive the most benefit from your prescription benefit, it's a good idea to create an account with CVS. Go to Caremark.com online or upload the CVS/Caremark mobile app. By creating an account you will be able to order fast refills, check benefit coverage, check drug cost, view prescription history and more. If you have questions for the pharmacist, call directly at 1-888-202-1654.
Participants will receive a new member packet by mail from CVS upon enrollment in a covered health plan. This packet will include a coverage description booklet, mail service claim forms and a separate participant identification card for use at retail pharmacies. The forms needed to use the mail service pharmacy or to submit claims for retail prescriptions are also available in the HR Forms Library.
Prescription CO-INSURANCE COSTS At A Glance
PRESCRIPTIONS FOR 85/60 PLANS
- 10% with an $80 maximum for each generic prescription
- 20% with an $80 maximum for each brand name prescription
- 40% with an $80 maximum for each brand name prescription when a generic is available.
- NOTE: Exception to the $80 maximum is when a brand name medication prescribed when a generic is available, the maximum co-insurance is $100 unless your physician specifies Dispensed as Written (DAW).
PRESCRIPTIONS FOR HDHP PLANS
Your HDHP requires you to pay the full negotiated cost for your care until you reach your deductible for most health care expenses, including most prescription medications. After you meet the deductible, you pay only the coinsurance and your plan pays the rest. If you are enrolled in a HDHP, using medications on the preventive drug list will reduce your cost for select prescriptions that help prevent chronic health conditions when taken regularly. If you take medications on the preventive drug list, you will pay only the copay or coinsurance for these medications even if you have not yet met your annual plan deductible.
- NOTE: During the initial deductible phase, prescriptions will be 100% of the negotiated price to the member until the deductible is met. Once the deductible is met, prescription co-insurance costs will be as follows:
- 10% with a $60 maximum for each generic prescription
- 20% with a $60 maximum for each brand name prescription
- 40% with a $60 maximum for each brand name prescription when a generic is available.
- NOTE: Exception to the $60 maximum is when a brand name medication prescribed when a generic is available, the maximum co-insurance is $100 unless your physician specifies Dispensed as Written (DAW).
CVS Health Customer Service: 1-888-202-1654 or http://www.caremark.com
- CVS Health Prescription Plan Booklet (PDF)
- CVS Health Reimbursement Form (PDF)
- Preventive Therapy Drug List for High Deductible Health Plan (PDF)
- Let's Talk Prescription - Preventive drug list for 85/60 and HDHP medical plans (PDF)
- Medications Requiring Prior Authorization (PDF)
- Advanced Control Specialty Formulary Drug List (PDF)