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When you elect medical coverage, you are automatically covered under a prescription drug plan. CVS Caremark is the pharmacy benefit manager for both medical coverage options. Show your CVS Caremark prescription ID card to your pharmacist each time you fill a prescription.

    CVS/Caremark Pricing Tools

    Price your medication using the following links to the Traditional and Consumer Select Rx pricing tools. The Consumer Select Rx pricing tool assumes you have not met your deductible under the plan. Prescription costs are estimated and may vary from your actual cost.

     

     

    Generic Step Therapy

You must try a generic medication first for certain drug classes before a brand name medication will be covered. If you are taking a brand name drug, discuss the option of taking a lower-cost generic drug with your doctor or pharmacist.

For medications covered by Generic Step Therapy, if you try a 30-day supply of a generic, and you and your doctor determine it is not the right medicine to treat your condition, you may fill a prescription for a brand medication and the usual cost share will apply. If you do not try a generic first, you will be required to pay the full cost of the brand drug.

Here are key points to remember:

  • Ask if a generic is available
  • Share your preferred drug list with your doctor to ensure he/she prescribes the most cost effective medications
  • Your pharmacist can help you find the lowest cost option for your condition. He/she may be able to contact your physician if you need a new prescription

You can also view a list of medications that require Generic Step Therapy. For more information, click here for Generic Step Therapy frequently asked questions. The plan supports you getting the most effective medication to treat your condition while helping you get the most for your money.

How the Plan Works

In the Consumer Select Plan, certain preventive care drugs, i.e. for treatment of high blood pressure, coronary disease, or asthma, are not subject to the deductible and are paid at regular copays or coinsurance. For all other drugs, you will need to meet the medical plan deductible before the plan pays for prescriptions. Click this link for a list of preventive prescriptions. For non-preventive prescriptions, after you meet your medical deductible, you’ll pay according to the drug type and supply you receive as shown below. What you pay for covered prescriptions counts toward your annual prescription drug out-of-pocket maximum shown in the table below. Once you reach this maximum, UH pays 100% of your eligible in-network prescription drug expenses for the rest of the year.

In the Traditional Plan, the deductible does not apply to prescription drugs, and all drugs are paid according to the copays and coinsurance in the chart below. What you pay for covered prescriptions counts toward your prescription drug out-of-pocket maximum shown in the table below. Once you reach this maximum, UH pays 100% of your eligible in-network prescription drug expenses for the rest of the year.

     
    Retail Pharmacy
    (30-day supply)
    Mail Order and
    CVS Pharmacy
    (90-day supply)
    Annual prescription drug deductible
        Consumer Select Plan
        Traditional Plan
     
    Must meet medical plan deductible for non-preventive drugs
    None
    Generic $15 $30
    Formulary brand name 30%, $30 minimum,
    $75 maximum
    20%, $60 minimum,
    $150 maximum
    Non-formulary 50%, $70 minimum,
    $200 maximum
    50%, $150 minimum,
    $400 maximum
    2017 Annual prescription drug out-of-pocket maximum
        Consumer Select Plan
        Traditional Plan

     
    Counts toward medical out-of-pocket maximum
    $2,500/individual or $5,000 per family

The cost for drugs is discounted at CVS Caremark in-network pharmacies and mail service. The Generic Step Therapy program has certain requirements in order to receive benefits.

How to Fill Your Prescriptions
You can choose to fill your prescriptions at:
  • Participating retail pharmacies
  • Through a mail order program if you take maintenance medications
  • Specialty medications are generally available through UH Specialty Pharmacy at
    1-800-552-8442. Click here for a list of specialty medications.

To find a CVS Caremark pharmacy near you, go to www.caremark.com to search by zip code or pharmacy name.

Is Your Medication Covered?

The prescription drug plan provides coverage for generic, formulary and non-formulary prescription drugs. To see your plans preferred formulary drug list go to www.caremark.com or call the CVS Caremark UH customer care team at 1-855-264-5047. Certain prescription drugs may require prior authorization, step therapy or require specific quantity limits as noted in the Summary of Benefits.

The plan covers drugs for smoking cessation and infertility, oral contraceptives and diabetic supplies. Here is an overview.

Smoking cessation drugs Prescription smoking cessation drugs are covered at 100% under the plan.
Infertility
drugs*
Prescription drug coverage is provided for the treatment of infertility. The prescription drug coinsurance for infertility drugs is 50%. This coinsurance does count toward the annual maximum out-of-pocket limit. The lifetime maximum benefit is $5,000.
Oral contraceptives* Oral contraceptives and contraceptive devices are covered. Contraceptive implants and devices are covered under the medical benefit*.
Diabetic supplies Meter strips, lancets, syringes, and needles for insulin injections, along with one glucose meter per year will be covered at one coinsurance per prescription. A maximum of 300 meter strips per person per month will be covered with additional available subject to prior authorization.

* For UH SJMC: Infertility drugs are not covered under the plans. Oral contraceptives and devices are covered outside of the UH medical plans.