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Prescription

Covid-19 Test Coverage

Free At-Home Covid Tests: As you most likely heard in the media, each residential household in the U.S. can now order four free at-home COVID-19 tests.  The rapid at-home tests can be ordered directly through the special USPS link below.  Through the order link, you only need to provide contact and shipping information – no billing information needed. https://special.usps.com/testkits

Community Testing Resources: Available at no or low cost.
I Need a COVID-19 Test (doineedacovid19test.com)
Community-Based Testing Sites for COVID-19 | HHS.gov

Plan Coverage: Effective January 15, 2022, coverage for over-the-counter rapid tests is available, restricted to 8 tests/month per plan participant. Plan participants can either visit an in-network pharmacy and have the test cost processed through insurance at the pharmacy counter, or tests can be purchased through a retailer and then submitted for reimbursement (reimbursed up to $12/test).  To submit a reimbursement request, either log into your account at caremark.com (Plan & Benefits > Submit Prescription Claim) or request reimbursement via the caremark app.


Access your Account

Access your Caremark Account: caremark.com

    • 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.

Prescription Coverage

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 – October 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 Advanced Control Formulary (covered prescriptions) here info.caremark.com/acdruglist. 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