Prescription Drugs

Chances are that at some point during the year, you or one of your family members will need medication. Whether it is an inhaler for your son’s asthma or antibiotics for an infection, it’s important to understand your prescription drug benefits.

• Your out-of-pocket costs depends on the tier of medication.
  • Preventive medications are covered by a copay. No deductible necessary!
  • Tier 1: Generic prescriptions are just as effective as name brand drugs at a fraction of the cost.
  • Tier 2: Preferred Brand prescriptions offer great value for a slightly higher copay.
  • Tier 3: Non-Preferred Brand prescriptions have the highest cost. Under the Preferred Drug Step Therapy (PDST) Process, you may be required to try a generic or preferred brand medication drug first before a tier 3 drug will be covered.
• Enrolled in the HDHP? The deductible must be met before the plan begins to pay.
• If you meet the out-of-pocket maximum, the plan will cover the full cost of your prescription drugs for the rest of the plan year.
• You can receive flu and shingles vaccines at no cost at your local pharmacy.
• For some medications, prior authorization and/or quantity limits may apply. CVS will ask your doctor some questions about your condition to make sure it’s the right medication for you.
• CVS will fully cover Emtricitabine/Tenofovir disoproxil fumarate (TDF) generic (200 mg/300 mg dose only) for HIV treatment and prevention. Since this medication is classified as preventive, you do not have to pay a copay or deductible. If you are not approved for this medication, you may request a formal appear or grievance from CVS.

Save Money with Mail-Order!
Using the Mail-Order program to fill prescriptions you take on a regular basis (maintenance medications) helps lower your out-of-pocket costs. This program saves you time and money by getting three months of medication for only two months’ worth of copays delivered right to your home, free of shipping.