How the Prescription Drug Plan Works

Free preventive generic drugs. Eligible preventive generic medications are covered at 100% with no deductible, copayments or coinsurance at network pharmacies.
Separate deductibles and coinsurance maximums than the Medical Plan;
MRA funds can be used to pay for covered out-of-pocket prescription drug costs;
Discounted prices that are available at network pharmacies (you'll generally pay more at an out-of-network pharmacy); if you use an out-of-network pharmacy that does not accept your prescription drug ID card, you will generally pay more and will need to file a claim for eligible reimbursement;
Option of having maintenance prescriptions filled through a convenient mail-order program or at a pharmacy;
Traditional (non-specialty) and specialty lists of preferred/covered and excluded drugs; the most recent lists can always be found on the CVS Caremark website; and
Mandatory Generic Drug Program; if you fill a prescription for a brand-name medication when a generic equivalent is available, you will pay the difference in cost between the brand-name drug and generic drug, plus the generic copay.

Free preventive generic drugs. Eligible preventive generic medications are covered at 100% with no deductible, copayments, or coinsurance at network pharmacies.
Preventive drugs are medications that can help prevent the onset of a condition if you are at risk or help you manage your health if you have a condition. CVS Caremark determines which drugs are considered "preventive generic" drugs. To see a list of drugs in this category, visit CVS Caremark's website accessible via My Health.

$10 copayment for non-specialty generic drugs (up to 30-day supply). You pay $10 for non-specialty generic drugs not considered preventive purchased at a network pharmacy. Non-specialty generic drugs are not subject to a deductible. If the cost of a generic drug is less than the $10 copayment, you'll pay the lower amount.
Annual retail deductible for brand-name and specialty generic drugs. An annual deductible of $100 per individual (with a maximum of $300 per family) applies to brand-name and specialty generic prescriptions filled at retail pharmacies. There is no deductible for non-specialty generic drugs or for 90-day supplies purchased at a CVS retail pharmacy or by mail.
Coinsurance for brand-name and specialty generic drugs. After you satisfy the retail deductible, you and the Plan share the cost of brand-name and specialty generic drugs through coinsurance.

Per-prescription maximum. The amount you pay for brand-name and specialty generic drugs each time you fill a prescription is capped by a per-prescription maximum, a safety net that protects against the cost of very expensive drugs. If the coinsurance amount is greater than the per-prescription maximum, you will pay only the amount of the maximum.
Cost savings for long-term maintenance medications. Maintenance Choice® offers advantageous pricing when you receive 90-day supplies of maintenance medication by mail or pick up your prescription at CVS retail pharmacies, where the same discounts are available. There is no deductible for maintenance medications received through Maintenance Choice®.
Annual out-of-pocket maximum. The annual out-of-pocket maximum is the overall "safety net" of your prescription drug coverage. The maximum caps your annual cost for covered prescriptions at $1,150 per individual (with a maximum of $2,300 per family), not including the deductible. Once an individual reaches this limit (or once the family meets the family limit), that individual (or family) does not have to pay anything further for covered drugs for the calendar year, regardless of coverage level.
The out-of-pocket maximum covers all copayments and coinsurance for covered drugs. It does not include the annual deductible for retail prescriptions or costs for non-covered drugs. Please Note: The prescription drug out-of-pocket maximum is separate from the Medical Plan's out-of-pocket maximum.
If you have money in your Medical Reimbursement Account (MRA), those funds are available to offset your share of the cost of your eligible covered medication.
If you have elected or were assigned automatic claim payment, at the time of purchase, your MRA funds will automatically be used to offset your out-of-pocket cost after the Plan pays its share of the cost of your medication. If you elected the debit card, you may pay your out-of-pocket costs by using the card or your own funds. If you pay out-of-pocket, you can submit a claim form for reimbursement from the MRA.
If you elected autopay during enrollment and subsequently receive a prescription drug coupon or prescription drug copay assistance card, you have the option to switch to debit card mid-year.
Once your MRA funds are depleted, you can use your HCSA for eligible prescription drug expenses if you elected to participate in the HCSA and have available funds.