[ HEALTH ]
PRESCRIPTON DRUGYour medical plan includes prescription drug benefits through CVS Caremark, and your costs and coverage depend on which medical plan you choose. Note that in both plans, your prescription costs count toward your medical plan annual deductible and out-of-pocket maximums.
| Plan | PPO: What You Pay | HDHP: What You Pay |
|---|---|---|
| Retail (30-day supply) | ||
| Generic | $10 copay | 20% after deductible |
| Preferred Brand | 25% after $30 minimum, up to a $75 max copay | 20% after deductible |
| Non-Preferred Brand | 40% after $50 minimum, up to a $125 max copay | 40% after deductible |
| CVS Retail or Mail Order (up to a 90-day supply) | ||
| Generic | $25 copay | 20% after deductible |
| Preferred Brand | 25% after $75 minimum, up to a $185 maximum copay | 20% after deductible |
| Non-Preferred Brand | 40% after $125 minimum, up to a $300 maximum copay | 40% after deductible |
| Specialty Pharmacy | ||
| Generic | $10 copay | 20% after deductible |
| Preferred Brand | 25% after $30 minimum, up to a $75 max copay | 20% after deductible |
| Non-Preferred Brand | 40% after $50 minimum, up to a $125 max copay | 40% after deductible |
| Preventive Drugs | 0% | 0% (deductible does not apply) |
| PrudentRx | 0%; if you don't enroll, 30% | 0% (deductible applies);if you don't enroll, 30% after deductible |
Important Notes: When a generic is available and you select the brand option, you will pay the cost for the generic plus the cost difference between the brand and the generic. Prior authorization and/or step therapy may apply for some prescriptions.
IF YOU ENROLL IN THE HDHP
You will pay 100% of the cost of your prescriptions until you satisfy the annual deductible, except for generic drugs on the CVS Caremark Generic Preventive Drug List (PDL). The plan also covers certain brand diabetic medications and supplies at 100%, with no deductible.
Once you meet the deductible, eligible drugs are covered as outlined in the above table, up to the medical plan out-of-pocket maximum. For generic drugs on the CVS Caremark Generic PDL, you do not have to meet the plan deductible, though coinsurance will apply and will count toward your out-of-pocket maximum. See more details here.
PRUDENTRX COPAY PROGRAM
The PrudentRx Copay Program allows you to get select specialty medications at no cost (HSA Plan participants must first satisfy the deductible). That means you pay $0 out-of-pocket for any medications on CVS Caremark’s exclusive Specialty Drug List when you fill with CVS Specialty®. You must enroll in the program to receive specialty drugs at $0. If you opt out of the program, you will pay 30% coinsurance for medications in the specialty tier.
