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PRESCRIPTION DRUG TIPS & RULES


 

TIP

WHY IT MATTERS

Use generics and formulary drugs when available

Choosing generic drugs helps lower prescription drug costs for both you and the company. Generic drugs are just as safe and effective as brand name drugs. Talk to your doctor about choosing a generic or brand formulary option.

BONUS: The Plan pays 100% of the cost of generic cholesterol and blood pressure medication. Diabetes supplies and insulin listed on the CVS formulary are 100% covered.

Use the CVS Caremark Retail Maintenance Choice Program or CVS Caremark Mail Order Services for maintenance drugs

You must use the CVS Caremark Retail Maintenance Choice Program or CVS Caremark Mail Order Services to fill your maintenance medication prescriptions. Maintenance medications are prescription drugs taken for chronic health conditions/concerns (e.g., high blood pressure and cholesterol).

NOTE: If you continue to order 30-day supplies of your maintenance medications without using the Maintenance Choice Program or Mail Order Services, you might have to pay the full cost of your maintenance medication prescriptions. However, if you find you are paying more for your maintenance medications under this program, contact CVS Caremark to discuss whether this program is right for you.

Use your HSA or FSA

Save money by paying for your prescriptions with tax-free dollars through a Health Savings Account (HSA) or the Health Care Flexible Spending Account (FSA).

Make sure you understand IRS reimbursement rules and how your medical option can affect your Health Care FSA.

PRESCRIBING RULE

WHY IT MATTERS

Dispense as Written penalty

If a generic drug is available, but your doctor notes “Dispense as Written/No Substitutions” on the prescription for the brand name drug, you will pay the coinsurance plus the difference between the generic and the brand price.

Quantity limits on certain drug classes (e.g., steroid inhalants, nasal steroids)

This helps ensure appropriate drug use.

Prior authorization for certain drug classes (e.g., androgens, antipsoriatics, ADHD agents)

This protects against off-label use.

Maintenance Choice Program

  • First maintenance medication: You may fill a 30-day supply at any pharmacy in the CVS network.
  • After one fill: You must fill maintenance medications in a 90-day supply through the Mail Service or at a CVS Pharmacy, including those inside Target stores.

No coverage for brand-name proton pump inhibitors or any non-sedating antihistamines

These are available over the counter with no prescription.


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