Prescription Plans
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, which differ by employee contribution rates, copays/coinsurance rates, and coverage for non-preferred drugs.
- Caremark Option A is frozen to current enrollees. If you elect to change out of the plan, you will not be able to re-enroll in it.
- If you enroll in a High Deductible PPO with HSA plan, you will pay all medical and prescription costs out of pocket until you reach your annual deductible. After you pay your deductible, you will pay copayments until you reach your annual out of pocket maximum.
Eligibility
You must be full-time benefits eligible (37.5 scheduled hours per week) or part-time benefits eligible (at least 17.5 scheduled hours per week) to enroll in prescription plans. Members of the Campus Police Association must be scheduled to work 40 hours per week to be full-time benefits eligible.
Prescription Coverage Comparison
| Caremark Option A (frozen to current enrollees) |
Caremark Option B |
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| In-Network Retail (up to 30-day supply) | ||
| Generic (automatic substitution) | $10 | $5 |
| Brand — Preferred | $25 | You pay 35% ($100 maximum) |
| Brand — Non-Preferred | $40 | You pay 100% |
| Specialty* | $100 | |
| Specialty — PrudentRx Eligible** | 30% coinsurance for eligible PrudentRx specialty prescriptions; $0 when enrolled in PrudentRx |
|
| Mail Order or Maintenance Choice (up to 90-day supply) | ||
| Generic (automatic substitution) | $20 | $10 |
| Brand — Preferred | $50 | You pay 35% ($200 maximum) |
| Brand — Non-Preferred | $80 | You pay 100% |
| Deductible and Annual Out-of-Pocket Maximum (OOP Max) | ||
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Deductible — Applies only to enrollees in High Deductible PPO with HSA. The Prescription plan deductible is combined with the Medical plan deductible. (see note) |
In-Network: $1,600 per individual / $3,200 per family Out-of-Network: $3,200 per individual / $6,400 per family |
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Annual Out-of-Pocket Maximum — Enrollees in High Deductible PPO with HSA. The Prescription plan OOP Max is combined with the Medical plan OOP Max. (see note) |
In-Network: $3,200 per individual / $6,400 per family Out-of-Network: $6,400 per individual / $12,800 per family |
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Annual Out-of-Pocket Maximum — Enrollees in PPO 1, PPO 2, HMO, and EPO medical plans. Separate from Medical OOP Max. |
Both In-Network and Out-of-Network: $2,650 per individual / $5,300 per family | |
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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 drug and the generic drug plus the generic copayment. Some drugs may be completely excluded from the plan. Contact Caremark at 844-910-3902 or access Caremark's Preferred Drug List. |
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*Specialty drugs must be filled through the CVS Specialty Pharmacy.
**If a participant's specialty medication is not on the PrudentRx list of eligible drugs, then the Specialty plan design will apply.
Summary of Benefits and Coverage Notices
Prescription Plan Rates
Check Medication Cost
- Caremark HDHP Option A or B (before deductible)
- Use this link to check medication costs under the High Deductible plan BEFORE hitting the deductible.
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Caremark Option A or Caremark Option B
- If enrolled in the High Deductible plan, use these links to view the cost of a medication AFTER meeting the deductible for the plan year.
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If enrolled in any other type of medical plan (PPO 1, PPO 2, HMO, EPO), use these links to view the cost of medications generally.
Check Medication Coverage
Carrier Resources
Caremark
- Customer Service: 844-910-3902
- Pre-authorization: 888-414-3125
- www.caremark.com