Carnegie Mellon University

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 available, which differ by employee contribution rates, copays/coinsurance rates, and coverage for non-preferred drugs.

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
Caremark
Option B
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 $100
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%
Annual Out-of-Pocket Max (separate from medical out-of-pocket max)
$2,650 individual/ $5,300 family $2,650 individual/ $5,300 family

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 877-347-7444 or access Caremark's Preferred Drug List.

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. View the CVS/Caremark Preventive Services List [pdf].

Diabetes Management

Carnegie Mellon offers the LivingMyLife® Program at no cost as part of the prescription drug program.

Carrier Resources

Caremark

Customer Service: 877-347-7444

Pre-authorization: 888-414-3125

www.caremark.com