CVS Caremark Co-Pays
| # | Drug Tier |
34-Day Supply Co-Pays |
90-Day Supply Co-Pays |
| 1. | Generic Medications | $10 | $20 |
| 2. | Preferred Brand-Name Medications | $30 | $60 |
| 3. | Non-Preferred Brand-Name Medications | $60 | $120 |
| 4. | Bio-Tech Drugs/Specialty Drugs | $75 | $100 1 |
| Annual Out-of-Pocket Co-Pay Maximum - Individual $1000 & Family $2000 |
1
Bio-Tech Drugs/Specialty Drugs in 90-Day Supplies Available for Rheumatoid Arthritis ONLY.
- Co-pay levels are based on the CVS Caremark Standard Formulary Drug List. To verify coverage and check costs, visit the CVS Caremark portal.
- Prior Authorizations will be required for:
- Some Formulary Medications
- Compound Medications over $300
- 90-day Supply Medications:
- May be filled at MSU Health Care Pharmacy or through CVS Caremark Mail Order
- Bio-Tech/Specialty Drugs are only allowed for Rheumatoid Arthritis
- See also the CVS Caremark Maintenance Choice Program FAQ
- A Preferred Brand-Name Medication is one that is listed on the plan’s formulary or preferred list of prescription drugs.
- A Non-Preferred Brand-Name Medication is one not included on the plan’s formulary or list of preferred prescriptions. Non-Preferred Brand-Name drugs have a higher co-insurance than Preferred Brand-Name drugs. You pay more if you use Non-Preferred drugs than if you opt for Generics and Preferred Brand-Name drugs.
- In addition to the co-pay, you may be responsible to pay a Dispense as Written (DAW) pricing penalty. This means you may be responsible for the difference between the Preferred or Non-Preferred Brand Name Medication and the Generic Medication. Note: Certain medications are excluded from the pricing penalty. A DAW pricing penalty brand exception may be requested and reviewed by CVS Caremark. Contact CVS Caremark at 800-565-7105 for details.
- If Preferred Brand-Name Medications or Non-Preferred Brand-Name Medications are selected you may have a pricing penalty. This means you will need to pay the difference in cost between the Brand-Name drug and Generic drug. The pricing penalty does not apply to all medications and is not the same as a co-pay.
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Some specialty drugs will require Step Therapy*. Step Therapy is a type of prior authorization that begins medication for a medical condition with the most cost-effective drug therapy and progresses to other more costly or risky therapies only if necessary. Specialty injectable medications (for conditions such as Hepatitis B & C, RSV, Hemophilia, Immune Deficiency, and Osteo & Rheumatoid Arthritis) are only covered through CVS Caremark Specialty Pharmacy. Please call 800-237-2767 for more information on this benefit.
- *Step Therapy is required for specific therapeutic classes under the Advanced Control Specialty Formulary. The 12 specialty classes are Autoimmune, CML, Fertility, Hematology, Hepatitis C, Growth Hormone, Multiple Sclerosis, Osteoarthritis, Osteoporosis, Prostate Cancer, Pulmonary Arterial Hypertension and Transplant.
Please Note:
Consumer Driven Health Plan (CDHP) with Health Savings Account (HSA) enrollees have different prescription benefits. Prescription drug costs under this plan are subject to plan deductible and co-insurance, and then the total cost is covered after they reach the out-of-pocket maximum. This means that enrollees will pay 100% of prescription costs until they reach their deductible. Once the deductible is met, MSU covers 80% of the costs while enrollees pay 20% co-insurance. Once the out-of-pocket maximum is reached, CDHP enrollees will have prescriptions covered 100%. Also under the CDHP, certain preventive generic prescription drugs for chronic conditions such as asthma, cholesterol, diabetes and anti-hypertensives are covered at 100% without a deductible or co-insurance (where a generic is available).
| CVS Caremark Customer Service | 800-565-7105 | www.caremark.com | |
