Prescription Drug

Administered by CVS Caremark, prescription drug coverage includes medically necessary drugs and medicines prescribed by your or your covered dependent’s doctor on an outpatient basis.

You’re automatically enrolled in prescription drug coverage if you are enrolled in the:

  • Enhanced-Surest option; or
  • Standard-Surest option.

Review the Medical Expense Plan Summary Plan Description (SPD) for details.

If you enroll in a Health Maintenance Organization (HMO), prescription drug coverage is provided through the HMO. Contact your HMO for details. HMO contact information is listed on the back of your medical ID card (if you are enrolled), in the current Benefits At-a-Glance and Resource Contact Information in the annual open enrollment section of this website and on the Your Benefits Resources (YBR) website.

How Prescription Drug Coverage Works

You can fill prescriptions:

  • At any retail pharmacy; or
  • By mail order (through CVS Caremark Mail Service Pharmacy).

To find an in-network retail pharmacy, visit Caremark.com (you will need to register the first time you visit the site) or call 1-800-240-9623.

For Retail Prescriptions for Acute Conditions (Up to a 30-Day Supply)
You can fill short-term prescriptions (up to a 30-day supply) for acute conditions at any retail pharmacy, although you will save money when you use an in-network pharmacy. Note that your prescription drug copayment will double after the third time you receive up to a 30-day supply of a maintenance medication at a retail pharmacy.

For example, if you are enrolled in the Enhanced-Surest option and receiving a preferred brand drug for high blood pressure, you will pay a $140 copayment (2 x $70 = $140) for up to a 30-day supply the fourth time you try to fill the prescription at a retail pharmacy. If you use CVS Caremark Mail Service Pharmacy or a CVS retail pharmacy to fill a 90-day prescription, you can get your 90-day supply for only $175. (See below for more information about filling prescriptions for up to a 90-day supply of maintenance medications for chronic conditions.)

If You Use an Out-of-Network Retail Pharmacy
When you use an out-of-network retail pharmacy to fill a prescription, you need to meet a separate prescription drug deductible before the plan will pay a percentage of the cost. You will need to pay the entire cost at the time of purchase. You will then need to file a claim with CVS Caremark to receive reimbursement for a percentage of the cost (if applicable).

For Maintenance Medications for Chronic Conditions (Up to a 90-Day Supply)
To fill prescriptions for any medications you or your covered dependents use on an ongoing basis for a chronic condition, such as high blood pressure or high cholesterol, you have two options:

  • Use CVS Caremark Mail Service Pharmacy. To get started, visit Caremark.com (you will need to register the first time you visit the site) or call 1-800-240-9623.
  • OR

  • Fill and pick up your prescription at a CVS retail pharmacy (including those in Target stores) at mail order pricing.
You can order up to a 90-day supply each time at a lower cost than three 30-day supplies at retail.

To Learn More About Your CVS Caremark Prescription Drug Benefits
Refer to the following resources:

For more information:

Costs

Contributions for prescription drug coverage are included with your medical coverage contributions. Your out-of-pocket costs vary depending on how you choose to fill your prescriptions. For instance, if you purchase a brand-name drug when a generic equivalent is available, you will pay the generic copayment, plus the difference in cost between the brand-name and generic drug.

Please note that deductibles and out-of-pocket maximums are in addition to any that you may be required to pay under your medical coverage option. For your specific costs, visit the YBR website.