Prescription Coverage

2022 Insurance Information

As part of ongoing efforts to expand Americans' access to free COVID-19 testing, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of over the counter (OTC), at-home COVID-19 test kits. 

On Saturday, January 15, individuals with private health coverage were able to begin obtaining OTC COVID-19 at-home test kits for free. Penn State’s CVS Caremark prescription coverage will cover the cost of OTC COVID-19 at-home test kits, for those employees and their families enrolled in a Penn State health plan.  

There is a limit of up to 8 OTC COVID-19 at-home test kits per covered member (meaning each covered family member) per 30 consecutive days. (If the kits contain 2 tests, then no more than 4 kits per 30 consecutive days).

Coverage/Reimbursement Options:

  1. Purchase OTC COVID-19 at-home test kit AT THE PHARMACY COUNTER of a participating pharmacy, with no up-front out of pocket costs. Members will need to present their CVS Caremark ID card at point of sale to the pharmacy. If you encounter an issue at the pharmacy counter processing your claim, please rest assured that you will be reimbursed up to the mandated limit, so please keep your receipt so you can submit a claim to CVS Caremark.

CVS Caremark has confirmed that the issue some are experiencing for option #1 above is not necessarily a systemic issue, as they are seeing adjudication at some pharmacies across the network, however, not consistently. The biggest challenges being experienced are due to capacity contraints and OTC test kit supply limitations. In some cases, pharmacies may be prioritizing dispensing medications that are provided with a valid prescription and administering vaccines over adjudicating OTC tests.

  1. Purchase OTC COVID-19 at-home test kits at a participating pharmacy, however, if purchasing the kits NOT AT THE PHARMACY COUNTER, members will be required to pay for the kit and then must submit a claim for reimbursement, via the CVS Caremark reimbursement page. The reimbursement will be the cost of the test itself, which may not include sales tax.  
  2. Purchase OTC COVID-19 at-home test kits at NON-PARTICIPATING PHARMACIES AND at NON-PHARMACY LOCATIONS, such as Amazon, however, the member will need to pay for the kit at the time of purchase and then must submit a claim for reimbursement. The maximum reimbursement for these tests will be $12.

Health plan enrolled employees needing further assistance in finding a participating pharmacy, reviewing the CVS Caremark COVID-19 Help Center online, or may have questions regarding a claim reimbursement, should visit CVS Caremark or contact them directly at 844.462.0203 for further assistance.

Prescription Coverage

As the novel coronavirus (COVID-19) continues to spread, you may have concerns about accessing prescription medications - especially if you or loved ones have a chronic or complex condition. CVS Caremark® and University Health Services (UHS) pharmacy are taking steps to protect faculty, staff, and retiree access to medication and we encourage you to refill maintenance medications with a 90-day supply or up to the plan maximum. Please contact UHS Pharmacy at 814-865-9321 or CVS Caremark at 844-462-0203 with any questions.

 

Preventive Drug List

PPO Savings Plan - No Deductible, Coinsurance Only

PPO Plan - Lower Coinsurance

View Preventive Drug List
Generic Drugs 10% coinsurance
Preferred Brand Drugs 20% coinsurance
Non-Preferred Brand Drugs 40% coinsurance

CVS Caremark Web Portal

Pricing Tools and Pharmacy Locator

If you are using manufacturer's discounts or incentives, or services like GoodRx, please note that the amount you pay will NOT be included in either the PPO Savings Plan deductible/coinsurance or the PPO Plan prescription out-of-pocket maximums. Please contact CVS Caremark at 844-462-0203 with any questions on using these types of services versus your Penn State health plan.

Mail Order Forms

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
Preferred Brand Drugs 20% coinsurance
Non-Preferred Brand Drugs 40% coinsurance
Mail Order
Generic Drugs 10% coinsurance
Preferred Brand Drugs 20% coinsurance
Non-Preferred Brand Drugs 40% coinsurance
Specialty
Preferred Drugs 20% coinsurance, $65 Minimum
Non-Preferred Brand Drugs 40% coinsurance, $100 Minimum
Out-of-Pocket Maximum Integrated with Medical

 

PPO Plan Prescription Coverage for Technical Service Employees
Generic Drugs 50% coinsurance
Preferred Brand Drugs 50% coinsurance
Non-Preferred Brand Drugs 70% coinsurance
Mail Order
Generic Drugs 20% coinsurance
Preferred Brand Drugs 20% coinsurance
Non-Preferred Brand Drugs 70% coinsurance
Specialty
Preferred Drugs 50% coinsurance, $50 Maximum
Non-Preferred Brand Drugs 70% coinsurance, $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
Preferred Brand Drugs 50% coinsurance
Non-Preferred Brand Drugs 70% coinsurance
Mail Order
Generic Drugs 20% coinsurance
Preferred Brand Drugs 20% coinsurance
Non-Preferred Brand Drugs 70% coinsurance
Specialty
Preferred Drugs 50% coinsurance, $50 Maximum
Non-Preferred Brand Drugs 70% coinsurance, $100 maximum
Out-of-Pocket Maximum $2,000/$8,000