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	90-day supplies of bio-tech/specialty drugs are not offered
Annual Out-of-Pocket Co-Pay Maximum
Individual $1000		Family $2000

 

• Co-pay levels are based on the CVS/Caremark Standard Formulary Drug List. To verify coverage and check costs, visit the CVS/Caremark portal.
• Some formulary medications may require a Prior Authorization.
• Please Note: Compound medications over $300 will require a Prior Authorization.
• 90-day supply medications (except for Bio-Tech/Specialty Drugs) may be filled at MSU Pharmacies or through CVS/caremark mail order. 90-day supplies of Bio-Tech/Specialty Drugs are not allowed.
• 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 drug is one not included on the plan’s formulary or list of preferred prescriptions. Non-preferred brand-name drugs have a higher coinsurance 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 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 drug and generic drug. The pricing penalty does not apply to all medications and is not the same as a co-pay. 
• 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 (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 1-800-237-2767 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:

CDHP with HSA enrollees have different prescription benefits. Prescription drug costs under this plan are subject to plan deductible and coinsurance, 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, and once the deductible is met, MSU covers 80% of the costs while enrollees pay 20% coinsurance. Once the out-of-pocket maximum is reached, CDHP enrollees will have prescriptions covered 100%. Also under the CDHP, preventive generic prescription drugs for asthma, cholesterol, diabetes and anti-hypertension are covered at 100% without a deductible or coinsurance (where a generic is available).  

CVS Caremark Customer Service

1-800-565-7105

www.caremark.com