There’s one big difference between the medical plans:
- With the HSA Medical Plan, prescription drug benefits are subject to your medical plan deductible (other than certain preventive medications).
- With the PPO Medical Plan, prescription drug benefits are NOT subject to the medical plan deductible.
| Plan Feature | In-Network Retail Pharmacy (30-day supply) |
Mail Order (90-day supply) |
|---|---|---|
| Generic Drugs | You pay 20% ($10 min/$25 max) | You pay 20% ($20 min/$50 max) |
| Preferred Brand Name | You pay 30% ($35 min/$75 max) | You pay 30% ($70 min/$150 max) |
| Non-Formulary Brand Name and Specialty Drugs | You pay 40% ($55 min/$120 max) | You pay 40% ($110 min/$240 max) |
| Specialty Drugs (only available as a 30-day prescription) |
You pay 20% generic ($10 min/$25 max) 30% preferred brand ($35 min/$75 max) 40% non-preferred brand ($55 min/$120 max) |
|
| PPO Medical Plan only: PrudentRx Specialty Drugs (visit prudentrx.com/prudentes for the full list) |
$0 copay if enrolled in PrudentRx 30% coinsurance, no minimum/no maximum, if NOT enrolled in PrudentRx |
|
Long-term Maintenance Medications
If you are using a long-term maintenance medication‚ you must obtain a 90-day prescription and fill it either through CVS mail order or at a retail CVS pharmacy. Non-maintenance medications or any 30-day prescription can be obtained through any network retail pharmacy.
You can save money on prescriptions by using generic prescription medicines instead of name brands, in-network pharmacies and medicines on CVS Caremark’s preferred drug list or formulary. In addition, certain preventive medications are covered at 100% (no deductible). Go to caremark.com to price your medication or view CVS Caremark’s preventive drug list and formulary.
While you need to fill your prescription through the CVS Caremark pharmacy network, this does not mean you need to use a CVS pharmacy (with the exception of long-term maintenance medications*). The CVS Caremark network includes other pharmacies like Walgreens, Rite Aid, Kroger, Meijer and many others. Visit caremark.com or call 855-310-4418.
*You have access to Costco Pharmacy (no membership required) as part of the Maintenance Choice program in all states except OK and WV. In select states, additional pharmacies may be in-network for 90-day supplies. If you need to locate a convenient in-network pharmacy, please visit Caremark.com/PharmacyLocator.
Cost Saving Prescription Programs
| GOOD Rx PROGRAMS | PRUDENTRx | Rx SAVINGS SOLUTIONS (RxSS) | |
|---|---|---|---|
| Medical Plan | If you’re enrolled in the HSA Medical Plan or the PPO Medical Plan | If you’re enrolled in the PPO Medical Plan Only | If you’re enrolled in HSA Medical Plan or the PPO Medical Plan |
| About the Program | Secures the lowest cost available for eligible non-specialty generic medications | Manufacturer copay assistance for certain specialty drugs | Helps find lower-cost medication options that treat your condition and are covered by your insurance |
| Enrollment | Automatically enrolled | Qualified members are contacted by PrudentRx. Subject to a 30% coinsurance if you do not enroll | You'll be contacted if there's a chance to save money on current prescriptions or new ones you start taking in the future |
| Contact | 855-310-4418 | 800-578-4403 | 800-268-4476 |
