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Prescription - Caremark

Caremark, Inc., administers the prescription drug benefits for all health plans. This prescription drug benefit allows you to obtain covered prescription drugs and diabetic supplies at a retail pharmacy or through a Caremark Mail Service pharmacy. Mail Service is required after two retail refills for all maintenance medications.

The plan encourages the use of generic medications or, if no generic medication is available, the medications listed on the Caremark Preferred Drug List. This drug list is provided is available on the Caremark website.  In order to get the drug list that your benefits cover, you must create an account with Caremark website or call Caremark directly at: 1-888-202-1654.

Participants will receive a new member packet by mail from Caremark upon enrollment in a covered health plan. This packet will include a coverage description booklet, mail service claim forms and a separate Caremark identification card for use at retail pharmacies. The forms needed to use the mail service pharmacy or to submit claims for retail prescriptions are also available in the HR Forms Library.

Prescription Benefits At-A-Glance

Retail Program

Mail Service

When To Use It

For immediate drug needs or short-term medications

For maintenance or long-term medications

You Pay

  • 10% with a $60 maximum for each generic prescription
  • 20% with a $60 maximum for each brand name prescription
  • 40% with a $60 maximum for each brand name prescription when a generic is available
  • *Exception to the $60 maximum is if you receive a brand name medication when a generic equivalent is available, the maximum co-insurance is $100 unless your physician has specified that the prescription be Dispensed as Written.
  • 10% with a $60 maximum for each generic prescription
  • 20% with a $60 maximum for each brand name prescription
  • 40% with a $60 maximum for each brand name prescription when a generic is available
  • *Exception to the $60 maximum is if you receive a brand name medication when a generic equivalent is available, the maximum co-insurance is $100 unless your physician has specified that the prescription be Dispensed as Written.

Days Supply

30-day supply

90-day supply

Refill Limit

Initial fill + 2 refills

None

Caremark Customer Service

1-888-202-1654 or http://www.caremark.com

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