The Health Savings Plan has three options from which you can select, differing only in individual/family deductible and Out-of-Pocket Maximum. Please see the table below for details.
HSP Option 1
HSP Option 2
HSP Option 3
(Deductible does not apply)
(Deductible does not apply)
The Health Savings Plan options have a combined medical and prescription drug deductible. 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.
Your prescription plan coverage is the same no matter which of the three HSP options you choose, HSP 1, HSP 2 or HSP 3. The only difference is the deductible and out-of -pocket maximum that will apply to your coverage depending on which HSP option you choose.
When you fill a prescription, you will need to pay the full discounted cost for drugs that aren’t on the Preventive Therapy Drug List until you meet your deductible. Once you meet the deductible, you will pay 20% and the plan will pay 80% of costs through coinsurance*.
How Your Coverage Works for 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 Preventive Therapy Drug List. When you choose them, your plan deductible doesn’t apply. Instead, the plan pays benefits for these drugs right away.
How Your Coverage Works for Non-Preventive Drugs For drugs that aren’t on the Preventive Therapy Drug List, you’ll pay the full discounted cost until you meet your combined medical/prescription drug deductible.
Maintenance Drugs You must fill maintenance prescriptions as a 90-day supply after the initial two 30-day fills of a maintenance drug. A CVS pharmacist will contact your prescribing doctor to update your maintenance drug prescription to a 90-day supply. Then, after the second fill of your maintenance drug, you’ll receive a 90-day supply.
Specialty Drugs Specialty Drugs are covered at $100 copay after deductible is met. Specialty drugs include certain injectable, inhaled, infused and oral drugs for conditions like rheumatoid arthritis or hemophilia. If you or a family member take specialty drugs and need help managing the cost, CVS Caremark Specialty Pharmacy may have options to make them more affordable. To learn more, call toll-free at 1-888-281-8186. Before you fill your prescription, prior authorization may be required. You must fill your prescription through CVS Caremark Specialty Pharmacy. You may have your prescription mailed to your home or sent to a retail CVS/pharmacy for convenient pick-up except in West Virginia and Arkansas. You must also use CVS Caremark Specialty Pharmacy 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 homecare, an ambulatory infusion center or a doctor’s office.
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
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, please visit caremark.com.