Prescription Coverage

For 2018, the prescription benefit provider will change to CVS Caremark. CVS Caremark is a leading pharmacy benefits manager with nearly 90 million plan members, nearly 9,700 retail locations, and more than 1,100 walk-in medical clinics. CVS Caremark offers a dedicated senior pharmacy care business serving more than one million patients per year, expanding specialty pharmacy services, and a leading stand-alone Medicare Part D prescription drug plan, the company enables people, businesses and communities to manage health in more affordable and effective ways. This unique integrated model increases access to quality care, delivers better health outcomes and lowers overall healthcare costs.

Mail Order Forms

The transition to CVS Caremark does not mean you can only use CVS pharmacies. You can fill your prescriptions:

  • At various chain and independent retail pharmacies (30-day supply).
  • At University Health Services (30 or 90-day supply).
  • Through CVS Caremark mail order services.
  • Via CVS Specialty if you are on a specialty medication.
PPO Savings Plan Prescription Coverage
Retail (30-day supply)
Generic Drugs 10% coinsurance
Formulary Brand Drugs 20% coinsurance
Non-Formulary Brand Drugs 40% coinsurance
Mail Order
Generic Drugs 10% coinsurance
Formulary Brand Drugs 20% coinsurance
Non-Formulary Brand Drugs 40% coinsurance
Specialty
Formulary Drugs 20% and $65 Minimum
Non-Formulary Brand Drugs 40% and $100 Minimum
Out-of-Pocket Maximum Integrated with Medical

Retail (31-day supply)

Generic Drugs 50% coinsurance
Formulary Brand Drugs 50% coinsurance
Non-Formulary Brand Drugs 70% coinsurance
Mail Order
Generic Drugs 20% coinsurance
Formulary Brand Drugs 20% coinsurance
Non-Formulary Brand Drugs 70% coinsurance
Specialty
Formulary Drugs 50% and $50 Maximum
Non-Formulary Brand Drugs 70% and $100 maximum
Out-of-Pocket Maximum $1,000/$6,000
PPO Plan Prescription Coverage for Faculty and Staff
Pharmacy
Retail (30-day supply)
Generic Drugs 50% coinsurance
Formulary Brand Drugs 50% coinsurance
Non-Formulary Brand Drugs 70% coinsurance
Mail Order
Generic Drugs 20% coinsurance
Formulary Brand Drugs 20% coinsurance
Non-Formulary Brand Drugs 70% coinsurance
Specialty
Formulary Drugs 50% and $50 Maximum
Non-Formulary Brand Drugs 70% and $100 maximum
Out-of-Pocket Maximum $2,000/$8,000