Page 7 - 2018 CareHere Enrollment
P. 7
CareHere
Prescription Drugs
The participating pharmacy network includes large drug store chains Important Note
such as Walgreens and CVS, as well as many independent pharmacies. Regarding Specialty
Your copayment for preventive prescriptions vary depending on the type Medications
of drug used to ill your prescription. Non-preventive prescriptions are
subject to the calendar year deductible and out-of-pocket maximum. The Plan Sponsor has
procurement programs in place
BCBST BCBST that may require participation
Provided by SAV-RX Option 1—TN Only Option 2 in the High Impact Advocacy
Network S Network P program. This program manages
Prescription Drugs* the use of selected specialty
Retail 30-Day Supply medications to reduce or eliminate
Generic $5 copay preventive Rx; $5 copay preventive Rx; your out-of-pocket expense, as
all other—20% after all other—20% after
deductible deductible well as reducing the cost to the
Preferred Brand $25 copay preventive $25 copay preventive plan sponsor. In order to continue
Rx; all other—20% after Rx; all other—20% after receiving your medication at
deductible deductible
Non-Preferred Brand $50 copay preventive $50 copay preventive the most affordable cost, your
Rx; all other—20% after Rx; all other—20% after prescription will be illed at the
deductible deductible Sav-Rx Specialty Pharmacy. Sav-Rx
Mail Order 90-Day Supply will facilitate your enrollment into
Generic $5 copay per 30 day $5 copay per 30 day
supply preventive Rx; supply preventive Rx; a manufacturer sponsored coupon
all other Rx—20% after all other Rx—20% after program. Program medications
deductible deductible
Preferred Brand $25 copay per 30 day $25 copay per30 day may be discontinued from
supply preventive Rx; supply preventive Rx; inclusion of the program at any
all other Rx—20% after all other Rx—20% after time without notice.
deductible deductible
Non-Preferred Brand $50 copay per 30 day $50 copay per 30 day
supply preventive Rx; supply preventive Rx;
all other Rx—20% after all other Rx—20% after
deductible deductible
* If you select a brand name drug when a generic equivalent is available, the plan will only pay
the cost of the generic drug.
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Prescription Drugs
The participating pharmacy network includes large drug store chains Important Note
such as Walgreens and CVS, as well as many independent pharmacies. Regarding Specialty
Your copayment for preventive prescriptions vary depending on the type Medications
of drug used to ill your prescription. Non-preventive prescriptions are
subject to the calendar year deductible and out-of-pocket maximum. The Plan Sponsor has
procurement programs in place
BCBST BCBST that may require participation
Provided by SAV-RX Option 1—TN Only Option 2 in the High Impact Advocacy
Network S Network P program. This program manages
Prescription Drugs* the use of selected specialty
Retail 30-Day Supply medications to reduce or eliminate
Generic $5 copay preventive Rx; $5 copay preventive Rx; your out-of-pocket expense, as
all other—20% after all other—20% after
deductible deductible well as reducing the cost to the
Preferred Brand $25 copay preventive $25 copay preventive plan sponsor. In order to continue
Rx; all other—20% after Rx; all other—20% after receiving your medication at
deductible deductible
Non-Preferred Brand $50 copay preventive $50 copay preventive the most affordable cost, your
Rx; all other—20% after Rx; all other—20% after prescription will be illed at the
deductible deductible Sav-Rx Specialty Pharmacy. Sav-Rx
Mail Order 90-Day Supply will facilitate your enrollment into
Generic $5 copay per 30 day $5 copay per 30 day
supply preventive Rx; supply preventive Rx; a manufacturer sponsored coupon
all other Rx—20% after all other Rx—20% after program. Program medications
deductible deductible
Preferred Brand $25 copay per 30 day $25 copay per30 day may be discontinued from
supply preventive Rx; supply preventive Rx; inclusion of the program at any
all other Rx—20% after all other Rx—20% after time without notice.
deductible deductible
Non-Preferred Brand $50 copay per 30 day $50 copay per 30 day
supply preventive Rx; supply preventive Rx;
all other Rx—20% after all other Rx—20% after
deductible deductible
* If you select a brand name drug when a generic equivalent is available, the plan will only pay
the cost of the generic drug.
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