Page 6 - 2020FCSBenefitsGuide
P. 6
CVS Caremark Administered by RxBenefits
X Fill at a CVS Pharmacy—ask your physician for a 90-day prescription;
then have your doctor send it to the CVS/pharmacy of your choice
X Mail order service—you can enroll easily online or by phone by
visiting www.caremark.com/mailservice and sign in or register to
request a new prescription, or call CVS/Caremark at 800.875.0867
The following are examples of how Rx deductible and copay are
applied—a 30-day ill and a 90-day ill for maintenance medications.
X 30-day Rx example: Bob ills his irst Rx in 2020 and the cost of
the medication is $38.50; Bob will pay the full $38.50; next month
Bob ills his second Rx and the cost is $150; Bob will pay the balance
of the $100 deducible ($61.50), then the $50 copay because this is a
non-preferred brand Rx; any prescriptions after this will simply be the
applicable copay
X 90-day maintenance Rx example: Bob ills his irst Rx in 2020 and
it is 90-day maintenance medication; the cost for a 90-day supply of
the medication is $300; Bob will pay the irst $100 and will satisfy his
deducible for the year; then, Bob will pay the $100 mail order copay
because this is a preferred brand medication he is illing at CVS and
the plan will pay the remaining $100; any prescriptions after this will
simply be the applicable copay
If either you or your doctor request a brand-name medication when
a generic equivalent is available, you will pay the brand copay plus the
difference in cost between the brand-name and the generic medication.
X Brand—30-day supply X Cost to member under
Y Total cost: $253 “Dispense As Written” penalty
Y Total copay: $40 Y Brand copay: $40
X Generic—30-day supply Y Difference in drug cost:
Y Total cost: $63.07 ($253–$63.07) $189.93
Y Total copay: $10 Y Total cost to member:
$229.93
6 2020 Benefits Guide
X Fill at a CVS Pharmacy—ask your physician for a 90-day prescription;
then have your doctor send it to the CVS/pharmacy of your choice
X Mail order service—you can enroll easily online or by phone by
visiting www.caremark.com/mailservice and sign in or register to
request a new prescription, or call CVS/Caremark at 800.875.0867
The following are examples of how Rx deductible and copay are
applied—a 30-day ill and a 90-day ill for maintenance medications.
X 30-day Rx example: Bob ills his irst Rx in 2020 and the cost of
the medication is $38.50; Bob will pay the full $38.50; next month
Bob ills his second Rx and the cost is $150; Bob will pay the balance
of the $100 deducible ($61.50), then the $50 copay because this is a
non-preferred brand Rx; any prescriptions after this will simply be the
applicable copay
X 90-day maintenance Rx example: Bob ills his irst Rx in 2020 and
it is 90-day maintenance medication; the cost for a 90-day supply of
the medication is $300; Bob will pay the irst $100 and will satisfy his
deducible for the year; then, Bob will pay the $100 mail order copay
because this is a preferred brand medication he is illing at CVS and
the plan will pay the remaining $100; any prescriptions after this will
simply be the applicable copay
If either you or your doctor request a brand-name medication when
a generic equivalent is available, you will pay the brand copay plus the
difference in cost between the brand-name and the generic medication.
X Brand—30-day supply X Cost to member under
Y Total cost: $253 “Dispense As Written” penalty
Y Total copay: $40 Y Brand copay: $40
X Generic—30-day supply Y Difference in drug cost:
Y Total cost: $63.07 ($253–$63.07) $189.93
Y Total copay: $10 Y Total cost to member:
$229.93
6 2020 Benefits Guide
