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Medical Prescription Drug Supplement Plan


  • Retail: 35% coinsurance with $35.00 max for generic drugs
  • Retail: 35% coinsurance with $70.00 max for formulary brand-name drugs
  • Retail: 60% coinsurance with $140.00 max for non-formulary brand-name drugs
  • Refill Limit: 3
  • Mail: 35% coinsurance with $35.00 max for generic drugs
  • Mail: 35% coinsurance with $70.00 max for formulary brand-name drugs
  • Mail: 60% coinsurance with $140.00 max for non-formulary brand-name drugs
  • Non-Participating Pharmacy Coinsurance or Non Participating direct claims:

  • 45%, No coinsurance max for generic and formulary brand drugs
  • 70%, No coinsurance max for non-formulary brand drugs
  • Annual Benefit Maximum per individual $3,500

    Mail service for long-term medications (up to a 90-day supply), and retail service for short-term medications (usually up to a 30-day supply)

    More than 64,000 pharmacies in the CVS Caremark network

    Choose mail service or a CVS pharmacy to fill your long-term medications. You will pay the same copay either way. Your copay may increase if you use another retail pharmacy.

    You usually pay less for your prescriptions when you use generic or formulary brand drugs. Non-formulary brand drugs may cost you more.

    Some medications require prior approval (or prior authorization) from your doctor before CVS Caremark can fill and cover your prescriptions.

    Download a copy of your Prior Authorization Drug List.

     




     
    Drug Cost
    GenericsAdvantage Program – (Member pays the difference in cost between generic and brand when a generic equivalent is available, example, Zocor, Prilosec). The cost of your medication on this website is incorrect and will appear higher than your actual cost.

    Extended Cycle Oral & Injectable Contraceptives – Please contact CustomerCare at 855-465-0030 to obtain the cost of this medication.

    You will be able to price your medication on www.caremark.com.

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