Prescription Drug Coverage

If you enroll in any of the medical plans, prescription drug coverage is provided for you and your enrolled dependents. The Prescription Drug Plan is currently administered by Caremark Prescription Services. Participating Caremark pharmacies offer discounted prices for prescription drugs. Most local and major pharmacy chains and supermarket pharmacies participate with Caremark, including, CVS, Drug Emporium, Eckerd, Rite-Aid, KMart, Walgreens, Pathmark, and Acme. Also, for your convenience, HUP pharmacy has been added as a participating pharmacy.

How The Plan Works - Coverage

When you use your Caremark card at participating pharmacies, you pay 10% of the discounted price for generic drugs (minimum co-insurance of $5) and 30% of the discounted price for brand name drugs (minimum co-insurance of $15) at the time of purchase. These same percentages apply to mental health related prescriptions. If you purchase brand name drugs that have generic equivalents, you'll pay the brand name coinsurance amount plus the difference in cost between the brand name and generic drug.
Most pharmacies are within the Caremark system. However, if you use a non-participating pharmacy, or do not use your Caremark member ID card, you can file a claim for reimbursement, but there will be a surcharge of 5% above the co-insurance amount of 10% for generic drugs and 30% for brand name drugs.
The maximum amount you may be responsible to pay out of your pocket for covered prescriptions within a plan year is $1,500 per individual and $4,500 per family (the additional cost of brand name drugs with generic equivalents is not included in this maximum).

Mail Order Program

Caremark offers mail order services for long-term maintenance prescriptions. The mail order program offers several advantages. For example:

You may obtain a three-month supply through this program instead of the single 34-day supply that you can receive through a retail supplier.
You pay the same coinsurance amounts as you do for retail prescriptions, but if you take a brand name drug for which there is no generic equivalent, you will pay only 20% of the cost of that drug through mail order ($20 minimum) instead of the normal 30% at retail. (Note that if you purchase brand name drugs that do have generic equivalents, you'll pay the 30% brand name coinsurance amount plus the difference in cost between the brand name and generic drug.)
You will enjoy lower minimum co-insurance amounts through mail order: $10 for a three-month supply of generic drugs and $30 for a three-month supply of brand name drugs - compared to $5 and $15 respectively for one-month supplies at retail.
You may order refills over the telephone or via Caremark's website.

More Information

For more information about prescription drug benefits, contact Caremark at 1-800-378-0802, or visit the Caremark Web Site at www.caremark.com