Prescription drug services (Caremark)

 

Caremark

Prescription drug mail service

The Pharmacy Plan, administered by Caremark, offers a prescription drug program that provides mail delivery service as well as in-network and out-of-network pharmacy benefits.

The following table presents prescription benefits. The coinsurance percentage amount that you pay and the annual out-of-pocket maximum may depend on the prescription option you selected in your plan. The pharmacy coinsurance rates represent the amounts paid by the participant.

2014 Update: Pre-Medicare and Medicare-Eligible Blue Cross Blue Shield Prescription Benefits – PPO (For more details, refer to page 74 in the 2014 Retiree Health Benefits Guide.)

 

PPO

Type

In-Network
Coinsurance

Out-of-Network
Coinsurance

Mail-Order Program*
Coinsurance

Generic Drugs

35%
of the total drug cost, for up to a 30-day supply

50%
of the total drug cost, for up to a 30-day supply

30%
of the total drug cost, for up to a 90-day supply

Brand-name Drugs**

35%
of the total drug cost, for up to a 30-day supply

50%
of the total drug cost, for up to a 30-day supply

30%
of the total drug cost, for up to a 90-day supply

Annual pharmacy deductible

No deductible

Annual pharmacy out-of-pocket maximum***

$5,000 individual / $10,000 family

* You can also fill 90-day prescriptions at retail CVS pharmacies for the same price as mail-order.

** If a generic is available and a brand-name drug is purchased instead, you pay the appropriate coinsurance for the brand-name drug cost plus the cost difference between the brand-name and generic drug. The cost difference does not apply towards the pharmacy annual out-of-pocket maximum — you must still pay the difference, even if your annual out-of-pocket pharmacy maximum has been met.

*** The cost difference you pay if a brand-name drug is received when a generic is available does not apply to the PPO annual pharmacy out-of-pocket maximum.

Visit the Caremark Web site for forms and a description of services offered, including online refill and order status, and your prescription history information. Due to privacy considerations, separate accounts must be set up for each dependent, in addition to the primary member. If you need assistance in setting up online accounts, contact the Caremark Internet Team at 800-990-1940. Caremark prescription drug claim forms are also provided on the TI benefits forms Web page.

Contact Caremark via HR Connect: 888-660-1411(or directly at 800-557-5749).

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