Prescription Drug Coverage

All three Medical Plan options include prescription drug coverage. Your prescription costs will depend on your Medical Plan selection.

Plan Features

  • Provided through CVS/Caremark
  • Maintenance medications are available at a 90-day supply. You can fill a 30-day and 90-day prescription at any CVS or Target pharmacy
  • If CVS pharmacies aren’t available in your area, your maintenance prescriptions must be filled using CVS/Caremark’s mail-order service (does not apply to associates living in Oregon)
Generic Drugs
  • Prescriptions are filled with generic drugs, if available
  • If a generic drug is available and you choose a brand name (or your doctor prescribes one), you must pay the difference in cost between the brand name and the generic – up to a maximum of $75 for retail (for a 30-day supply) and $187.50 for a 90-day supply – plus the cost for the brand
Step Therapy
  • If your doctor prescribes a brand-name medication that has a generic alternative, you must try a generic alternative for at least one month
  • At the end of the month, you can remain on the generic medication or switch to the brand name
  • If you don’t try the generic alternative and you continue to take the brand-name drug, you will be required to pay the full cost of the brand-name drug
  • You may need to repeat this process (trying a generic for at least one month) every two years
  • If your doctor believes you should take a brand-name drug instead of a generic, he/she can request an exception by calling 877-203-0003. The doctor will need to provide your name, CVS/caremark member ID (found on your prescription drug card) and your date of birth.
  • CVS/caremark will review each request independently and base its approval on the medical necessity of the brand-name medication. Your doctor may have to resubmit this request every two years
CVS/caremark Maintenance Choice*
  • All prescriptions for maintenance medications (for chronic, long-term conditions, such as high blood pressure, high cholesterol, diabetes, etc.) must be filled as a 90-day supply
  • You may get a 90-day supply at a CVS pharmacy or through mail order
  • Whether you choose delivery by mail or pick-up at a CVS pharmacy, you’ll pay the lower cost
  • You’ll be notified by CVS/caremark if you fill prescriptions for medications that fall under this program
  • Switching your prescription to Maintenance Choice is easy
On-Demand Delivery
  • If you live within 50 miles of a CVS pharmacy, CVS will ship a 90-day supply of maintenance medications, short-term antibiotics, and medical supplies directly to your home within 1-2 days at no charge
  • If you live within 10 miles of a CVS pharmacy, your order can be delivered within four hours for a small charge
  • Contact your local pharmacy for details
  • Note: Not currently available at Manhattan, New York and Puerto Rico stores, as well as Navarro pharmacies in South Florida
Specialty Medications
  • Dispensed exclusively through CVS/caremark’s specialty pharmacy
  • Mail your prescriptions to the specialty pharmacy or have your prescribing physician send them electronically
  • As an added convenience, you may drop off and pick up your specialty drug prescriptions at a local CVS pharmacy
Tobacco Cessation
  • Many prescriptions are available at no cost to you, like bupropion (Zyban) and varenicline (Chantix)
  • Plan covers all over-the-counter (OTC) products and prescription drugs related to smoking cessation at no cost (limited to two 12-week cycles each calendar year)
    • Your doctor can give you, or call in, a prescription for an OTC tobacco cessation product so you pay nothing for the product
    • Or you can pay the full cost of the item at the store and submit claim to CVS/caremark for reimbursement