Prescription Drug Supplement Plan

Retail: 20% coinsurance with $25.00 max for generic drugs

Retail: 20% coinsurance with $50.00 max for formulary brand-name drugs

Retail: 45% coinsurance with $100.00 max for non-formulary brand-name drugs

Refill Limit: 3

Mail: 20% coinsurance with $25.00 max for generic drugs

Mail: 20% coinsurance with $50.00 max for formulary brand-name drugs

Mail: 45% coinsurance with $100.00 max for non-formulary brand-name drugs

Non-Participating Pharmacy Coinsurance or Non Participating direct claims:

30%, No coinsurance max for generic and formulary brand drugs

55%, No coinsurance max for non-formulary brand drugs

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.