Prescription drug coverage is subject to the CVS Caremark Formulary. A formulary is a list of commonly prescribed medications that have been shown to be clinically effective and affordable. To find out if your drug is on the CVS Caremark Formulary, visit info.caremark.com/oe/broadridge or call Customer Care at 1-855-695-2093 (TTY: 711).

When you fill your prescription, a generic drug will automatically be dispensed, if available. If you request a brand-name drug (preferred or non-preferred) when a generic equivalent is available, you will pay the generic coinsurance amount plus a penalty — the difference between the brand cost and the generic cost. The difference in cost will not count toward your out-of-pocket maximum.

If you are taking a maintenance medication, the first three prescriptions (of a 30-day supply each) that you fill at a retail pharmacy will be charged at the 30-day supply coinsurance percentage. Thereafter, if you choose to continue to refill your 30-day supply at a retail pharmacy every month instead of opting for a 90-day supply through the CVS Caremark Maintenance Choice® Program (CVS mail order pharmacy or at a participating CVS or Costco Pharmacy), you will have a higher cost share that will not count toward your out-of-pocket maximum.

With Maintenance Choice, you have the option to pick up or get delivery of 90-day supplies of the medication you take regularly (for things like diabetes, high blood pressure, asthma, etc.) at select participating pharmacies. Sign in to Caremark.com/PharmacyLocator to find a participating pharmacy.

Preventive medications help prevent disease and help you manage existing conditions to avoid future complications. If you enroll in the SavingsPlus HSA medical plan option, certain preventive drugs are not subject to your annual deductible and are covered at 100%. To view a complete list of preventive medications covered by this program, visit info.caremark.com/oe/broadridge.

ACA preventive medications are covered at 100%, regardless of whether the applicable deductible has been met, in all of the medical plan options.

CVS Specialty® dispenses oral and injectable specialty medications for the treatment of complex chronic diseases. Specialty medications must be filled via CVS Specialty exclusively. For more information or if you need help, call CVS Specialty at 1-800-237-2767 (TTY: 711).

PrudentRx – If you are taking a specialty medication, you need to enroll in the PrudentRx Copay Program and PrudentRx will work with you to obtain third-party copay assistance for your medication. For members with HSAs: (i) for drugs listed on the plan’s HDHP Preventive Drug List, you will have a $0 out-of-pocket responsibility for your prescriptions covered under the PrudentRx Solution; and (ii) for all other drugs, you will have a $0 out-of-pocket responsibility for your prescriptions covered under the PrudentRx Solution after your deductible has been satisfied. When using this assistance, plan members may pay nothing out of pocket for medications on the specialty drug list dispensed by CVS Specialty. If you choose not to enroll in the PrudentRx program, medications in the specialty tier that are eligible for the PrudentRx program will be subject to a 30% coinsurance and the amount you pay out of pocket may not apply to your deductible and/or out-of-pocket maximum. Also, payments made by you for a medication that does not qualify as an “essential health benefit” under the Affordable Care Act (ACA), will not count toward your ACA out-of-pocket maximum (if any), unless otherwise required by law.

Cost Saver, when available, helps you pay less for eligible generic prescriptions. Just present your CVS member ID card when you pick up your prescription and the program will manage the rest for you. The program chooses the lowest cost automatically — no other action is required.