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

Prescription Plans

Prescription drug coverage is provided through CVS/Caremark for all our medical plans. If you elect medical coverage through Carnegie Mellon, you must select a prescription plan to cover the same individuals. If you opt out of our medical coverage, you cannot enroll in prescription coverage separately.

There are two prescription coverage options through Caremark, with different monthly rates. The plan that is right for you depends on your level of prescription drug usage. Both plans include the ExtraCare Health program, which provides a 20% discount on over-the-counter CVS-brand FSA-eligible products. (You need not be enrolled in the Health Care Flexible Spending Account to receive this discount.)

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— Formulary
—No generic available
—Generic available
$20
$25
35%
($100 max)
Brand Name—Non-formulary

$40*

Not Covered*

Mail Order or Maintenance Choice (Up to 90-day supply)
Generic (automatic substitution)
$20
$10
Brand Name— Formulary
—No generic available
—Generic available
$40
$50
35%
($200 max)
Brand Name—Non-formulary
$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-formulary medications will be covered at the "formulary—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 formulary medicine can not be used (and/or why a non-formulary 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 Summary of Benefits and Coverage Notices

Maintenance Drug Retail Penalty

If you purchase 30-day supplies of your maintenance prescriptions at a retail pharmacy, an additional charge will apply after the third monthly fill of the same maintenance drug at a retail pharmacy. The penalty is waived when you use the Caremark Maintenance Choice program.

Carrier Resources

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

Pharmacy Locator

Check Drug Cost
(click on "Check Availability & Cost")

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].