Prescription Plans-HR @ Carnegie Mellon University - Carnegie Mellon University

Prescription Plans

The information on this page is reflective of the 2016 benefit plan offerings; for information on 2017 benefit plan offerings, please visit the 2017 Open Enrollment site.

Carnegie Mellon prescription coverage through CVS/Caremark provides access to numerous chain and independent pharmacies, in addition to mail order service for maintenance medication.

There are two plan options available, which differ by employee contribution rates, copays/coinsurance rates, and coverage for non-preferred drugs.

Employees who enroll in medical plan coverage through CMU must select prescription drug coverage for the same individuals covered under the medical plan. If an employee opts out of medical plan coverage, he/she cannot enroll in prescription drug coverage.

Prescription Drug Participant Copays/Coinsurance

Caremark
Option A
Caremark
Option B
In-Network Retail
(Up to 30-day supply)
Generic (automatic substitution)
$10
$5
Brand Name— Preferred
—No generic available
—Generic available
$20
$25
35%
($100 max)
Brand Name—Non-Preferred

$40*

Not Covered*

Mail Order or Maintenance Choice (Up to 90-day supply)
Generic (automatic substitution)
$20
$10
Brand Name—Preferred
—No generic available
—Generic available
$40
$50
35%
($200 max)
Brand Name—Non-Preferred
$80*
Not Covered*
Annual Out-of-Pocket Max (separate from medical out-of-pocket max)
 
$2,100 individual
/ $4,200 family
$1,500 individual
/ $3,000 family
*Prior Authorization—Medical Necessity Waivers: Non-preferred medications will be covered at the "preferred—no generic available" level if they are deemed medically necessary. Your doctor must submit a Prior Authorization request in advance by calling 1-888-414-3125 to demonstrate why the preferred medicine can not be used (and/or why a non-preferred medication must be used).
Please note: When a generic is available, but the pharmacy dispenses the brand-name medication for any reason, you will pay the difference between the brand-name medication and the generic plus the generic co-payment.

Prescription Drug Rates

Monthly rates are shown; divide rate by two to obtain biweekly rates.

These prescription plan rates do NOT include the cost of medical coverage. You must cover the same set of individuals under both your medical and prescription coverage.

2016 Prescription Drug Rates for Full-Time Faculty and Staff

For a printable version of these rates, view the 2016 Domestic Full-Time Employee Rate Sheet [pdf].

Coverage Level

Option A
Option B
Employee
$64
$7
Employee & 1 Child
$144
$29
Employee & 2+ Children
$164
$35
Employee and Spouse/Domestic Partner
$184
$41
Family
$263
$66

2016 Prescription Drug Rates for Part-Time Faculty and Staff

For a printable version of these rates, view the 2016 Domestic Part-Time Employee Rate Sheet [pdf].

Coverage Level
Option A
Option B
Employee
$100
$37.50
Employee & 1 Child
$187.50
$72.50
Employee & 2+ Children
$211
$82
Employee and Spouse/Domestic Partner
$235
$92
Family
$328.50
$131.50

Prescription Drug Summary of Benefits and Coverage Notices

Carrier Resources

Caremark
Customer Service: 877-347-7444
Pre-authorization: 888-414-3125
www.caremark.com

Pharmacy Locator

Direct Reimbursement Form [pdf]

CVS/Caremark Mobile App Information [pdf]

Preventive Care Services

Your health plan offers certain preventive service benefits at no cost to you. These no-cost benefits are part of the Affordable Care Act (ACA). View the CVS/Caremark Preventive Services List [pdf].