Prescription Drug Coverage

If you enroll in any of Penn’s medical plans, prescription drug coverage is provided for you and your enrolled dependents. The prescription drug plan is administered by CVS/caremark for all medical plans. Coverage differs, however, depending on which medical plan you select.

You can fill your prescriptions at CVS pharmacies as well as a wide network of non-CVS pharmacies. The online Pharmacy Locator Tool can help you find a network pharmacy in your area.

Maintenance medication and the 90-day retail pick-up option are only available at CVS pharmacies. You may also use the CVS/caremark Mail Service pharmacy to receive your maintenance medications at your address of choice.

 

Coverage and Cost

The way your prescription drug coverage works is based on which medical plan you select. If you enroll in the Aetna High Deductible Health Plan (HDHP), your coverage will be structured differently than Penn’s other medical plans.

No matter which medical plan you select, the cost for prescription drug coverage is built into your medical coverage rate.

Use the drug cost estimators listed below to check the costs of your prescription under various Penn medical plans.

 

No-Cost Preventative Services

Penn's health plans now offer certain preventive service benefits— such as medicines, supplements, health-related products or vaccines— at no cost to you. This means you don’t have to pay a copay* or coinsurance, even if you haven’t met your deductible. These no-cost benefits are part of the Affordable Care Act (ACA).

Click here to download a list of no-cost preventative services. Other rules and limits may apply. Please contact your health plan provider for a complete coverage and list details.

PennCare/Personal Choice PPO, Aetna Choice POS II, and Keystone/AmeriHealth HMO Plans

When you’re enrolled in any of these plans, the amount you pay for prescriptions depends on the type of medication and how you buy it:

  • When you go to a retail pharmacy, you pay less if you use a participating in-network pharmacy.
  • You can use the CVS/caremark Mail Service for long-term maintenance medications. The mail order program offers several advantages including home delivery, three-month supplies, and lower minimum and maximum coinsurance amounts.

  • If you can use a generic drug, you save money: not only do you pay a lower coinsurance, but that lower coinsurance is a percentage of a lower base price.

The table below shows how you can save significantly in two areas by making wise purchasing decisions:

  • Get 90-day supplies of maintenance drugs If you use a retail pharmacy for more than three 30-day fills of a maintenance medication, you’ll pay double the normal coinsurance amount as well as double the minimum and maximum copays. If, however, you get 90-day supplies, your coinsurance and copays remain the same no matter how many refills you get.
  • Use generic drugs if possible If you choose to get a brand-name drug instead of an available generic equivalent, you pay a percentage of the cost of the brand-name version PLUS the cost difference between the brand name and the generic—and this difference doesn’t count toward the minimums and maximums.

Current Plan Year (2017-2018)

PennCare/PersonalChoice PPO • Aetna Choice POS II • Keystone/AmeriHealth HMO

 

Generics

Brand Name
without Generic Equivalent

Brand Name
with Generic Equivalent*

Speciality
 

Coinsurance, Minimum and Maximum Payment

Non-maintenance drugs

30-day supply (any network
retail pharmacy)

Coinsurance 10%

$7.50 min/$20 max

Coinsurance 30%

$15 min/$100 max

Coinsurance 10%+

$15 min/$100 max

N/A

Maintenance drugs

30-day supply (any network
retail pharmacy, up to 3 fills)**

Coinsurance 10%

$7.50 min/$20 max

Coinsurance 30%

$15 min/$75 max

Coinsurance 10%+

$15 min/$100 max

N/A

30-day supply (any network
retail pharmacy, after 3 fills)**

Coinsurance 20%

$15 min/$40 max

Coinsurance 60%

$30 min/$150 max

Coinsurance 20%+

$30 min/$200 max

N/A

90-day supply
(any network retail pharmacy or mail order)

Coinsurance 10%

$15 min/$40 max

Coinsurance 20%

$20 min/$100 max

Coinsurance 10%+

$30 min/$200 max

20%; $20 min/$100 max

Annual Out-of-Pocket Maximum

 

$2,000 individual/$6,000 family

* For brand names with a generic equivalent, you pay a percentage of the brand name cost PLUS the cost difference between brand name and generic. The cost difference between brand name and generic does not count toward the minimums and maximums.

** After three 30-day fills, you will pay double the normal coinsurance amount, as well as double the minimum and maximum coinsurance payments. You can save money by ordering 90-day supplies through the CVS/caremark Mail Service program or at CVS pharmacies.

***  Specialty drugs can be dispensed at CVS Pharmacies, CVS Specialty Mail Service, pharmacies at the Hospital of University of Pennsylvania, Penn Presbyterian Medical Center, Pennsylvania Hospital and Penn Medicine Radnor.

Aetna High Deductible Health Plan (HDHP) with a Health Savings Account (HSA)

When you’re enrolled in this plan, the amount you pay for prescriptions depends on whether your prescription is a preventive generic drug or something else. Generic preventive drugs are not subject to the deductible; for all other drugs, you must reach your deductible before the plan covers any costs.

Current Year (2017-2018)

 Aetna High Deductible Health Plan (HDHP) with a Health Savings Account (HSA)

Annual Deductible*

$1,500 individual/$3,000 family

Annual Out-of-Pocket Maximum*

$3,000 individual/$6,000 family

Preventive Generic Drugs (any retail or mail order, maintenance or non-maintenance)

10%, no deductible

Preventive Brand Name Drugs (with or without generic equivalent, any retail or mail order, maintenance or non-maintenance)

10% after deductible

Non-Preventive Drugs (generic or brand, with or without generic equivalent, any retail or mail order, maintenance or non-maintenance)

10% after deductible

* Amounts you pay toward medical and behavioral health/substance abuse also count toward the deductible and out-of-pocket maximum. After the out-of-pocket maximum is reached, all covered prescription drugs are paid at 100%.

Creditable Coverage Notice

Read the Creditable Coverage Notice, which describes Penn’s prescription drug coverage and your options under Medicare’s prescription drug coverage. It will help you decide whether you want to join a Medicare drug plan.




Questions? Contact CVS/caremark: 1-844-833-6390 or www.caremark.com.