Prescription


COVID-19 Update: Making sure you have access to an adequate supply of your medications is a priority.  Access info.caremark.com/COVID19/ to learn more about mail order and fill options.

Prescription Coverage

Check Drug Cost and Coverage – You can view drug cost and coverage levels by logging into your account at caremark.com (use your medical member ID number) > Plan & Benefits > Check Drug Cost & Coverage.  This will provide information on whether the drug is covered by the formulary, whether there are any therapeutic alternative drugs, and the cost comparison between retail locations and mail order.

Below is a summary of prescription coverage for Foth medical plan participants. Eligible prescriptions apply to the medical plan (see Medical for plan design).  Note: If you meet your out-of-pocket for the year, all covered prescriptions are covered at 100%.

Preventive Prescriptions – View the Preventive Therapy Drug List – March 2021  It is highly recommended you check this list if you take regular prescriptions to see if the preventive benefit applies.  If you are on a preventive prescription, you’ll want to consider filling through either CVS Mail Order or at a CVS retail location for the best price and coverage (either $0 for generics, or 20% coinsurance for brands!)  This list is subject to change.

Preventive Generic:
CVS (mail order or retail location): $0 (100% paid by plan)
Other pharmacy: Subject to deductible, then 20% (80% paid by plan) co-insurance

Preventive Brand:
CVS (mail order or retail location): 20% (80% paid by plan)
Other pharmacy: Subject to deductible, then 20% (80% paid by plan) co-insurance

All Non-Preventive Prescriptions –  You can view the current formulary (covered prescriptions) by logging into your account at caremark.com > Plan & Benefits > Covered Drug List (Formulary) > Advanced Control Formulary.  If your provider thinks there is a clinical reason why the drugs on the formulary won’t work for you, they can call CVS Caremark toll-free at 1-855-582-2026 to request a formulary exception.  Approved formulary exceptions requests will be subject to the deductible and non-preferred coinsurance.

Non-Preventive Tier 1 & 2 Prescriptions – Generic and Brand
All pharmacies: Subject to deductible, then 20% (80% paid by plan) co-insurance

Non-Preventive Tier 3 Prescriptions – Generic and Brand
All pharmacies: Subject to deductible, then 50% co-insurance

CVS Mail Order

To fill a prescription through CVS Mail Order, first ask your doctor to send the prescription to CVS Mail Order.  Once complete, visit caremark.com > Prescription, to order and set up automatic refills, if applicable.

Diabetes

CVS offers a free Accu-Chek® blood glucose meter program. Call the CVS Caremark Diabetic Meter Team at 1-800-588-4456 to order a new meter. If there is a clinical reason why you are unable to use the covered test strips, the formulary appeals exceptions process may accommodate your needs.

Specialty Pharmacy

For participants with specialty prescription(s), you’ll need to fill your prescription through CVS Specialty Pharmacy.  To order a prescription or contact the CVS Specialty Pharmacy team, call 1-800-237-2767.

Additional Resources

Request/Print additional Medical/Prescription ID card

There’s an app for that: Download the CVS Caremark app for on-the-go access to helpful tools and resources.  You can access your ID card, manage mail order prescriptions (order, check status, update shipping and billing information), locate nearby pharmacies, and check drug costs and coverage.

ACA Preventive Services List – No Cost

Questions?

 Benefits/Human Resources

Enrollment, plan changes & general benefits inquiries: Benefits@Foth.com