Page 18 - 2021 Mid Year Open Enrollment 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
Primary/Preferred Drug List drug coverage. Non-preventive prescription drug when it is convenient for you
The prescription drug plan follows the prescribing recommendations in the CVS Caremark expenses will apply toward your medical plan Confidential, tamper Same-day prescription
Primary/Preferred Drug List (CVS Drug List). This list is periodically updated by the CVS Caremark deductible and out-of-pocket maximum. resistant packaging availability
National Pharmacy and Therapeutics Committee. Drugs may be removed from the CVS Drug List Talk to a pharmacist Talk face to face with a
if they become offered as a generic, are available over-the-counter (OTC), are discontinued by the These plans offer the same Preferred Drug List by phone pharmacist
manufacturer, and/or have other cost effective alternatives. The latest CVS Drug List is available at or Formulary as the Standard Plan. When you
www.caremark.com. 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
Generics First Line of Prescribing deductible, you will pay 20 percent of the medication through coinsurance and the plan will pay 80
This prescription drug plan automatically substitutes a generic for a brand name drug when a percent, until you have met your out-of-pocket maximum.
generic equivalent is available.
Preventive Therapy Drug List
Coverage of Contraception for Women under Health Care Reform Under the Core and Buy-Up Plans, IRS regulations require that medications must be subject to the
In accordance with the federal guidelines issued for Women’s Preventive Services as part of the deductible with the exception of specific preventive medications. As a result, if you are enrolled in
Affordable Care Act, the plan provides coverage of the full range of FDA approved contraceptive these plans and taking a medication that is on the Preventive Therapy Drug List, you will only pay 20
methods at NO cost to the member for generics and approved brand names. No-cost contraception percent of the discounted cost of the drug; the deductible will NOT apply for these medications. CVS
is available in both retail and mail order. Caremark periodically updates the Preventive Therapy Drug List and is available on the Company
intranet.
Step Therapy Program NOTE: A 90-day supply of FREE generic maintenance medications is NOT available on these plans,
Certain classes of drugs require the member to first try a less expensive, but therapeutically except as required by law, such as women’s contraceptives.
equivalent, preferred drug before ‘stepping up’ to a more expensive brand name drug. The drug
classes requiring participation in the step therapy program can be found on the company Provisions that Apply ONLY to the Standard PPO Plan
intranet.
ANNUAL DEDUCTIBLE UNDER THE STANDARD PPO PLAN
Maintenance Choice® for 90-day Supply of Maintenance Drugs You will pay the first $100 of the discounted cost for prescription drugs for each member of your
family (limited to $200 for employee plus one dependent, and limited to $300 for Employee plus
If you or a family member take a maintenance drug to manage a chronic health condition, such as two or more dependents). The annual deductible applies to non-maintenance generic and brand-
high blood pressure, asthma, diabetes, or high cholesterol, you have a choice on how you get your name drugs.
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! Tiered Copays
Covered prescriptions have tiered copays. These tiers are broken out for:
Get the CVS/Caremark App • Generic Drugs
Get easy refills, timesaving tools and convenient savings with the app, at caremark.com, or by • Brand Name Formulary (preferred brand names)
scanning the QR code.
• Brand Name Non-Formulary (non-preferred brand names)
• Specialty Prescriptions

16 • 2021 BUILDERS FIRSTSOURCE MID-YEAR BENEFITS GUIDE 2021 BUILDERS FIRSTSOURCE MID-YEAR BENEFITS GUIDE • 17