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Prescription Coverage

RXGroup# RX1896
RXBin# 004336

Benefit Period January 1, 2022 – December 31, 2022

Medications When You Need Them

CVS Caremark is the prescription plan carrier. Your prescription drug program allows you to obtain medications via mail or your in-network, local retail pharmacy. If you take certain medications on an ongoing basis, you save time and money by having those drugs filled for a 90-day supply through the CVS Caremark Mail Service or your local CVS pharmacy. Be sure to ask your doctor for a 90-day supply of your maintenance drugs.

Your prescription drug benefits are separate from your medical benefits. You have a separate CVS Caremark ID card that should be used at the pharmacy when filling prescriptions.

Benefit Retail 34 Day Supply Retail 90 Day Supply Mail Order
90 Day Supply
Generic $10 copay $20 copay $20 copay
Preferred Brand $20 copay $40 copay $40 copay
Non-Preferred $40 copay $80 copay $80 copay
Specialty $50 copay N/A N/A
Non Preferred
ED Drugs
$50 copay N/A N/A
Prilosec OTC ** $10 copay N/A N/A
Claritin OTC ** $10 copay N/A N/A
Nexium $100 copay $200 copay $200 copay

**In order to be charged the $10 copay for these medications, you must have your doctor write a prescription for the medication and present it to the pharmacy like any other prescription.

Maintenance Medications

All maintenance medications will need to be filled for a 90-day supply through mail order or at a CVS Pharmacy.

After two 30-day fills of maintenance medications, these are your only options for filling 90-day supply medications.

To enroll in the mail order prescription program please complete the Mail Order Form and submit it with a 90-day prescription from your physician.

When filling a maintenance drug, you’ll pay 2 months of a copays but receive 3 months’ worth of medication.

Mail Order

It is easy to enroll in the Mail Order prescription program. Employees must complete the Mail Order Form and submit it with a 90-day prescription from their physician. Mail order forms are available on this site (see link at right) or in the Employee Benefits Office.  When filling a maintenance drug, you’ll pay 2 months of a copays but receive 3 months worth of medication.

Specialty Medications

Specialty medications will be supplied by CVS Caremark. See the Specialty Medications document that is available on this site (see link at right) or in the Employee Benefits Office. Specialty medications will have their own copay of $50.

Compound Medications

Certain ingredients are excluded from coverage. If you are prescribed a compound medication that contains one of the excluded ingredients, it will not be covered.

Quantity and Duration Limitations

Some medications are only covered up to a certain limit. If your medication has a quantity limit, you, your doctor, or your pharmacist can call CVS Caremark at (888) 202-1654 to begin the review process.