Page 23 - 2020 Benefits Guide

Enrollment in the pharmacy benefit plan occurs automatically
when you enroll in one of the Company medical plans. You will
receive a Caremark ID card to use when filling prescriptions.

Comparison of 90-Day Supply Choices
Advantages of Caremark Mail Order Advantages of CVS Drug Store
Pick up your medications directly from the CVS
Convenient home delivery
store when it is convenient for you
Confidential, tamper-resistant Same-day prescription availability
packaging
Talk to a pharmacist by phone Talk face to face with a pharmacist

Provisions that Apply Only to the
Provisions That Apply ONLY to the Standard PPO Plan
Consumer Plan (HDHP) Annual Deductible under the Standard PPO
The Consumer Plan combines the
deductible for both medical and prescription Plan
drug expenses. When you enroll in the You will pay the first $100 of the discounted
Consumer Plan, CVS Caremark will cost for prescription drugs for each member
administer your prescription drug coverage. of your family (limited to $200 for employee
Non-preventive prescription drug expenses plus one dependent, and limited to $300 for
will apply toward your medical plan Employee plus two or more dependents).
deductible and out-of-pocket maximum The annual deductible applies to non-
maintenance generic and brand-name drugs.
The Consumer Plan offers the same
Preferred Drug List or Formulary as the Tiered Copays
Standard Plan. When you fill a non- Covered prescriptions have tiered copays.
preventative prescription, you will pay the full
discounted cost of the medication until you These tiers are broken out for:
have met your deductible. Once you meet • Generic Drugs
the deductible, you will pay 20 percent of • Brand Name Formulary (preferred brand
the medication through coinsurance and the names)
plan will pay 80 percent, until you have met • Brand Name Non-Formulary (non-
your out-of-pocket maximum. preferred brand names)
• Specialty Prescriptions
Preventive Therapy Drug List
Under the Consumer Plan, IRS regulations
require that medications must be subject to
the deductible with the exception of specific
preventive medications. As a result, if you
are enrolled in the Consumer Plan 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 Caremark periodically
updates the Preventive Therapy Drug List
and is available on the Company intranet.

Note: A 90-day supply of FREE generic
maintenance medications is NOT available
on the Consumer Plan, except as required Collette Boyd, IT Data Analyst
by law, such as women’s contraceptives. Dallas, TX 22 22