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Prescription Drug Benefits

Prescription drug coverage is available in two convenient ways: either through the Retail Pharmacy program (up to a 30-day supply) or the Mail Services Pharmacy program (up to a 90 day supply) Both programs are administered by CVS/Caremark.

Effective July 1, 2018, the Plan has moved to a formulary based prescription benefit. The formulary helps highlight cost saving opportunities for you, helps guide selection for your doctor and proves overall value to the Plan. Individuals impacted by the changes will be provided advanced notification. The formulary is accessible at www.caremark.com/acdruglist. You are encouraged to register on Caremark's website and/or download the smart phone app. Use the Check Drug Cost feature to help find cost saving opportunities. Always ask your doctor or pharmacist if there is a generic drug to treat your condition. If your doctor thinks there is a clinical reason why any of the drugs on the drug list won't work for you, your doctor can call CVS/Caremark toll-free at (855) 582-2026 to request approval.

 

Retail Pharmacy Program

The Plan covers up to a 30-day supply of medication from a retail pharmacy. This benefit is designed for short-term or single use medications.  A list of CVS/Caremark pharmacies can be obtained by accessing the CVS/Caremark website at www.caremark.com, through CVS/Caremark's smart phone app, by calling CVS/Caremark customer care at (877) 478-1246, or contacting the Administrative Office.

Mail Service Pharmacy Program

The Plan covers up to a 90-day supply of medication from a mail-order pharmacy. This benefit is designed for long-term or maintenance medications.  Using Caremark via mail or internet, you may receive a 90-day supply for the price of 60-days! You should contact the mail service pharmacy at least two weeks before you need your next fill to allow for processing and mailing of the prescription.

The Plan allows for you to refill your prescriptions after 2/3 of the prescribed dosage has been used.
 

Cost Share for Medical Plans 500, 551 to 554, COBRA Plans 570, 590 to 593, and all Retiree Plans

Effective July 1, 2018, the Plan moved to the following cost share structure:

Type of Prescription          (Tier Category) Retail Cost Share
(Up to 30 day supply)
Mail Service Cost Share
(Up to 90 day supply)
Affordable Care Act Preventive Drugs $0.00 $0.00
Tier- 1                (Formulary Generics) $15.00 $30.00
Tier-2                 (Formulary Preferred Brands) $35.00 $70.00
Tier- 3                       (Non-Formulary Brands, Non-Preferred Brands) $50.00 $100.00
Formulary Exclusions and Brands with a generic equivalent substitute

You pay 100% of the cost. An exceptions process may accommodate medical necessity. If approved, the applicable copay applies. You may be required to try more than one formulary or generic product. Any prior exception requests may be subject to review. The Plan may not cover all products.

Your annual out-of-pocket limit for prescription drugs is $750.00 per person or $1500.00 per family.  Should you select a brand name medication when a generic is available, your prescription will not be covered by the Plan. If you do not use your ID card, or use a non-member pharmacy, the difference between the retail charge and the contracted rate will not apply to your out-of–pocket maximum.
 

Utilization Management of Diabetic Test Strips
Effective July 1, 2018, the plan will limit the quantity of diabetic test strips dispensed at one time. The limit will accommodate recommended testing guidelines by the American Diabetes Association (ADA). Your doctor may request higher limits from CVS/Caremark

 

Claims Review of Non-Specialty Drugs Exceeding $1,500.00
Effective July 1, 2018, non-specialty drugs exceeding $1,500.00 will be reviews by a Consultant Pharmacist to help ensure appropriate use and billing (dose, quantity, days' supply, charged amounts) or to discuss possible alternative. You, your doctor or pharmacy may be contacted by a Consultant Pharmacist.

 

 

 

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