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Your Health Savings Plan (HSP) Prescription Benefits


How the HSP Options Work


You automatically get prescription drug coverage when you enroll in CVS Health medical coverage. Your prescription drug coverage is adminstered by CVS Caremark®. The HSP options have a combined medical and prescription drug deductible. Your deductible amount is based on the HSP option you choose, and whether you cover only yourself (“individual”) or yourself plus one or more dependents (“family”).

You can choose from one of three HSP options. The plans differ in the deductibles and out-of-pocket maximums. Please see the table below for details.

HSP Option 1
HSP Option 2
HSP Option 3
  Individual Family Individual Family Individual Family
Deductible $1,500 $3,000 $2,000 $4,000
$3,000 $6,000
Out-of-Pocket Maximum $3,000 $6,000 $5,000 $10,000
$6,000 $12,000
Preventive Generics
(Deductible does not apply)
$0 $0 $0 $0 $0 $0
Insulin on the HSP Preventive Therapy Drug List
(Deductible does not apply)
$0 $0 $0 $0 $0 $0
Preventive Brands-Name Drugs
(Deductible does not apply)
20% 20% 20% 20% 20% 20%

Even though CVS Caremark® administers your prescription drug coverage, your non-preventive prescription drug expenses count toward your combined medical and prescription deductible and out-of-pocket maximum. You will pay the full discounted cost for non-preventive health care services and prescriptions out of your pocket until you reach your deductible. You must meet the full family deductible before CVS Health will share the cost of services if you cover one or more dependents.

Once you meet the deductible, you and CVS Health share the cost of services through coinsurance* — you pay 20% and CVS Health pays 80% — until you reach your out-of-pocket maximum. You can use the money CVS Health contributes to your Health Savings Account to help you pay for out-of-pocket expenses.

Preventive care is always covered at 100%. For example, there is no cost to you for generic preventive medications and brand-name insulin on the HSP Preventive Therapy Drug List.

Once you reach the out-of-pocket maximum, CVS Health will cover 100% of the cost of any additional covered expense for the rest of the plan year (June 1 – May 31).

Important: This is how your HSP option’s family out-of-pocket maximum will work:



  • Once a covered family member reaches the plan’s individual out-of-pocket maximum, CVS Health will cover 100% of the cost of covered expenses for that family member for the rest of the plan year.
  • Expenses for all covered family members will continue to count toward the family out-of-pocket maximum.
  • Once the family out-of-pocket maximum is met, CVS Health will cover 100% of the cost of covered expenses for all covered family members for the rest of the plan year.
  • How Your Coverage Works:

    Preventive Prescription Drugs

    Our Health Savings Plan (HSP) options help you stay on the path to better health with lower costs for certain preventive drugs that control cholesterol, high blood pressure and other health risks. These types of drugs are on the HSP Preventive Therapy Drug List. When you choose them, your plan deductible doesn’t apply. Instead, the plan pays benefits for these drugs right away.

  • You pay nothing for all generic preventive drugs on the list.
  • You pay nothing for all brands of insulin on the list.
  • You pay 20% of the discounted cost of brand-name preventive drugs on the list.
  • Non-Preventive Prescription Drugs
    You pay the full discounted cost until you meet your combined medical/prescription drug deductible for drugs that are not on the HSP Preventive Therapy Drug List.


  • For Non-Specialty Drugs: You pay 20% of the discounted cost and the plan pays 80% after you meet your deductible.
  • For Specialty Drugs: You pay a $100 copay after you meet your deductible.

  • Maintenance Drugs
    You must fill maintenance prescriptions as a 90-day supply after two initial 30-day fills. A CVS pharmacist will contact your prescribing doctor to update your maintenance drug prescription to a 90-day supply. After the second 30-day fill of your maintenance drug, you’ll receive a 90-day supply going forward.

    Specialty Drugs
    Specialty drugs are covered at $100 copay after you meet your deductible. Specialty drugs include certain injectable, inhaled, infused and oral drugs for conditions like rheumatoid arthritis or hemophilia. You must fill your prescription through CVS Specialty™. Before you fill your prescription, a prior authorization may be required. You may have your prescription mailed to your home or sent to a CVS Pharmacy® retail location for convenient pick-up.**

    You must also use CVS Specialty to coordinate in-network home nursing or care from an ambulatory infusion center for specialty drugs that require skilled nursing for injection or infusion. A CareTeam nurse will work with your provider to assess, on a therapy-specific and member-specific basis, the clinically-appropriate options for your infusion. Options may include home care, an ambulatory infusion center or a doctor’s office.

    If you or a family member take specialty drugs and need help managing the cost, CVS Specialty may have options to help make them more affordable. To learn more, call toll-free at 1-888-281-8186 or visit the Specialty Pharmacy website at www.CVSSpecialty.com.

    Quantity Limit and Prior Authorization
    Some medications have quantity limits or prior authorization requirements. When you use "Check Drug Cost" on this page, you may not see a price for some medications that require prior authorization or have quantity limits.† Please call Customer Care toll-free at 1-866-284-9226 to receive a cost estimate.


    Customer Care Toll-free Phone Number
  • 1-866-284-9226

  • For more information about your medical and prescription benefits, please visit myBenefits Spotlight: From myHR, select the link to myBenefits Spotlight. If you are currently enrolled and wish to check drug costs under your current plan year, please visit www.caremark.com.

     
    Check Drug Cost**
     

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