Page 15 - 2022_OE Benefits Guide

Prescription Benefits Provisions That Apply ONLY to the COMPARISON OF 90-DAY SUPPLY CHOICES
Core and Buy-Up Plans (HDHP)
Caremark’s network includes CVS, Walgreens, Target, Walmart, Longs, Rite Aid, Costco, Sam’s Clubs, The Core and Buy-Up Plans combine the Advantages of Caremark Advantages of
and most supermarkets and independent pharmacies (as of the printing of this guide). deductible for both medical and prescription Mail Order CVS Drug Store
Visit www.caremark.com for a current list of participating pharmacies, or call 1-844-431-4881. drug expenses. When you enroll in these plans, Pick up your medications
CVS Caremark will administer your prescription Convenient home delivery directly from the CVS store
PrudentRX drug coverage. Non-preventive prescription drug when it is convenient for you
New for 2022, PrudentRX has collaborated with CVS Caremark to offer a third-party (manufacturer) expenses will apply toward your medical plan Confidential, tamper Same-day prescription
copay assistance program that may help save you money on your specialty prescription. If eligible, deductible and out-of-pocket maximum. resistant packaging availability
you'll pay $0 out-of-pocket for medications on your plan's specialty drug list as well as select Talk to a pharmacist Talk face to face with a
high-cost limited distribution drugs as outlined within the PrudentRX Copay Program drug list. Team These plans offer the same Preferred Drug List by phone pharmacist
members eligible to participate in this program will receive a separate mailing directly from CVS or Formulary as the Standard Plan. When you
Caremark. fill a non-preventive prescription, you will pay
the full discounted cost of the medication until you have met your deductible. Once you meet the
Primary/Preferred Drug List deductible, you will pay 20 percent of the medication through coinsurance and the plan will pay 80
percent, until you have met your out-of-pocket maximum.
The prescription drug plan follows the prescribing recommendations in the CVS Caremark
Primary/Preferred Drug List (CVS Drug List). This list is periodically updated by the CVS Caremark
National Pharmacy and Therapeutics Committee. Drugs may be removed from the CVS Drug List Preventive Therapy Drug List
if they become offered as a generic, are available over-the-counter (OTC), are discontinued by the Under the Core and Buy-Up Plans, IRS regulations require that medications must be subject to the
manufacturer, and/or have other cost effective alternatives. The latest CVS Drug List is available at deductible with the exception of specific preventive medications. As a result, if you are enrolled in
www.caremark.com. these plans and taking a medication that is on the Preventive Therapy Drug List, you will only pay 20
percent of the discounted cost of the drug; the deductible will NOT apply for these medications. CVS
Generics First Line of Prescribing Caremark periodically updates the Preventive Therapy Drug List and is available on the Company
This prescription drug plan automatically substitutes a generic for a brand name drug when a intranet.
generic equivalent is available.
NOTE: A 90-day supply of FREE generic maintenance medications is NOT available on these plans,
Coverage of Contraception for Women under Health Care Reform except as required by law, such as women’s contraceptives.
In accordance with the federal guidelines issued for Women’s Preventive Services as part of the Provisions that Apply ONLY to the Standard PPO Plan
Affordable Care Act, the plan provides coverage of the full range of FDA approved contraceptive ANNUAL DEDUCTIBLE UNDER THE STANDARD PPO PLAN
methods at NO cost to the member for generics and approved brand names. No-cost contraception You will pay the first $100 of the discounted cost for prescription drugs for each member of your
is available in both retail and mail order.
family (limited to $200 for employee plus one dependent, and limited to $300 for Employee plus
two or more dependents). The annual deductible applies to non-maintenance generic and brand-
Step Therapy Program name drugs.
Certain classes of drugs require the member to first try a less expensive, but therapeutically
equivalent, preferred drug before ‘stepping up’ to a more expensive brand name drug. The drug Tiered Copays
classes requiring participation in the step therapy program can be found on the company Covered prescriptions have tiered copays. These tiers are broken out for:
intranet. • Generic Drugs

Maintenance Choice® for 90-day Supply of Maintenance Drugs • Brand Name Formulary (preferred brand names)
If you or a family member take a maintenance drug to manage a chronic health condition, such as • Brand Name Non-Formulary (non-preferred brand names)
high blood pressure, asthma, diabetes, or high cholesterol, you have a choice on how you get your • Specialty Prescriptions
medications. You can get a 90-day supply of your maintenance medications through Caremark’s mail
order system or pick up your medicine at a neighborhood CVS drug store – the choice is yours!

Get the CVS/Caremark App
Get easy refills, timesaving tools and convenient savings with the app, at caremark.com, or by
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