Prescription - CVS Health
CVS Health administers prescription drug benefits for all health plans.
This prescription drug benefit provides insurance coverage for eligible prescription drugs and durable medical supplies including Diabetic supplies at a retail pharmacy or through CVS Health Mail Service pharmacy. Mail service or CVS pharmacy pickup is required after two retail refills for a maintenance/lifetime medications.
To receive the most value from your prescription benefit, it's a good idea to create an account with CVS. You can do this at online or by uploading the CVS/Caremark mobile app. With a CVS/Caremark account you will be able to order fast refills, check benefit coverage, compare costs, view prescription history and more. If you have questions for the pharmacist, call directly at 1-888-202-1654.
Participants will receive a new member packet by mail from CVS upon enrollment in a covered health plan. This packet will include a coverage description booklet, mail service claim forms and a separate participant identification card for use at retail pharmacies. The forms needed to use the mail service pharmacy or to submit claims for retail prescriptions are also available at the bottom of this page.
Employees considering which medical plan to choose can also call the CVS Caremark customer care team at 1-888-202-1654 to request a check to compare the costs of their prescriptions on the 2 plans. The customer care team member can then use test IDs (or UIDs) to run these comparisons, upon request.
HOW DOES MY PRESCRIPTION COVERAGE WORK WHEN ENROLLED IN A HIGH DEDUCTIBLE HEALTH PLAN?
When enrolled in the High Deductible Health Plan, you can expect to pay the full negotiated price for any prescriptions that are not on the Preventative Drug List until your HDHP annual deductible is met. The cost of these prescriptions will go towards meeting your annual deductible. Once your deductible is met, your prescription co-insurance will apply and the maximum you would pay for your prescription will be $60.
Remember, you can contact CVS/Caremark at 1-888-202-1654 to check pricing information for prescriptions under the HDHP plan.
*Prescription co-insurances:
- 10% coinsurance of the negotiated price for generic medications
- 20% coinsurance of the negotiated price for brand-name prescriptions when a generic equivalent is not available
- 40% coinsurance of the negotiated price for brand-name prescriptions when a generic equivalent is available
*If you or your dependents are taking prescriptions appearing on the Preventive Therapy Drug List (PDF), the cost of that drug is not subject to your deductible. However, co-insurance will apply as stated above and the co-insurance amount will be applied toward your combined medical/prescription maximum out-of-pocket deductible.
CVS is collaborating with PrudentRx to offer a program that can save you money and reduce your out-of-pocket costs for covered specialty medications.
As part of your prescription plan with CVS/Caremark, the PrudentRx Copay Program allows you to get any of your covered specialty medications from the specialty drug list for $0 when you fill at CVS Specialty. Employees using specialty medications who choose not to enroll with PrudentRx will be responsible for 30% of the cost of those specialty medications.
If you have any questions about the program, call PrudentRx at 1-800-578-4403, Monday through Friday from 8 a.m. to 9:30 p.m., or Saturday from 9 a.m. to 6 p.m. Eastern Time.
CVS Health Customer Service: 1-888-202-1654 or
- CVS Health Prescription Plan Booklet (PDF)
- CVS Prescription Reimbursement form (PDF)
- Preventive Therapy Drug List for High Deductible Health Plan (PDF)
- CVS Formulary List - Prior Authorization Needed (PDF)
- Let's Talk Prescription - Preventive drug list for 85/60 and HDHP medical plans (PDF)
- Specialty Drug List (PDF)
- Advanced Control Specialty Formulary (PDF)
- Performance Drug List - Standard Control for Clients with Advanced Control Specialty Formulary (PDF)