Prescription Drug plan

The prescription drug plan is administered through CVS/caremark. Employees are automatically enrolled for prescription drug coverage in CVS/caremark when they enroll in one of the health plans (Community Blue PPO, Blue Care Network (BCN) or CDHP with HSA).

Co-Pays

Coverage & Eligibility Information

Prescription Drug Program FAQs

MSU HealthTeam Pharmacy

Prescription Reimbursement Claim Form

Visit the CVS/Caremark website

As of January 1, 2016, MSU follows the CVS/caremark Standard Formulary 1 process.

  • Co-pay levels will be based on the CVS/caremark Standard Formulary Drug List. To verify coverage and check costs select one of the following links:

Standard MSU Plan 

CDHP plans

  • Some formulary medications may require prior-authorization
  • 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
    • Transplant
  • Refills for medications after 1/01/16 are subject to the new process. Authorizations granted prior to 1/01/16 are honored through the approved end date.   

  • Some drugs are no longer on the formulary.  Options may be available at a lower cost.

  • The Exception Process has changed for requesting a pricing penalty override. This process must be initiated by your physician. The form is available on the CVS/caremark website. Employees need to create an account to access the form.

  • 90-Day supply of medications (except for Bio-Tech Specialty Drugs) are still available through MSU Pharmacies or through CVS/caremark mail order.

  • The “dispense as written” pricing penalty still applies  A pricing penalty is applied when a

    • Direct generic equivalent is available but not selected or

    • Generic equivalent in the same class of Drugs is available, but not selected.

  • Note: Members are responsible for paying their co-pays in addition to the pricing penalty.

 

1 A drug formulary is a list of prescription drugs, both generic and brand name, used by practitioners to identify drugs that offer the greatest overall value. A committee of physicians, nurse practitioners, and pharmacists maintain the formulary.