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:
- 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.
- 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.
- 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 | |||
Pricing Tools and Pharmacy Locator
- PPO Plan Faculty/Staff Pharmacy Pricing Tool
- PPO Plan Technical Service Pharmacy Pricing Tool
- PPO Savings Plan Pharmacy Pricing Tool (Before Deductible Met)
- PPO Savings Plan Pharmacy Pricing Tool (After Deductible Met)
- Pharmacy Locator Tool
- Diabetic Supply Coverage
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.
| 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 |
| 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 |
| 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 | |||