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855-619-9400 i
caremark.com

Prescription Drug Plan Ways to Stay Healthy and Save Money

Maintenance Choice
Plymouth Rock’s Prescription Drug Program is administered by CVS Caremark. When you enroll in This program allows you and your dependents to receive 90-day supplies of maintenance medications at the cost of
medical coverage, your prescription drug coverage is automatically included; there is no separate only two co-pays. You save the cost of one co-pay and time going to the pharmacy every month! Employees are required
enrollment and no additional cost. Each enrolled member will receive a CVS Caremark ID card to to fill their 90-day supply at a CVS Pharmacy or through the CVS Caremark Mail Service Pharmacy. You cannot fill a
present at participating pharmacies. 90-day supply at a different pharmacy.
For each new prescription, there is a grace period that allows for two 30-day fills at a local pharmacy. After the grace
period, you must obtain a new 90-day prescription. Otherwise, you will pay the full price for the medication.
Consumer Choice HSA Open Access Plus Open Access Plus In-Network
(HSA) (PPO) (EPO)
Retail: 30-Day Supply How to Get Started with Maintenance Choice
Generic Preventive $5 Co-pay N/A N/A
• Obtain New Prescription. Please contact your doctor to provide you with a 90-day supply prescription for
$10 after deductible
$10 Co-pay
$10 Co-pay
Generic $30 after deductible $30 Co-pay $30 Co-pay your maintenance medication to be filled through CVS Pharmacy or Mail Service (whichever you prefer)
PHYSICAL WELL-BEING Non-Preferred Brand $50 after deductible $50 Co-pay $50 Co-pay Generic Drugs PHYSICAL WELL-BEING
in order to avoid any disruption to your medication.
Preferred Brand
• Sign up for Mail Service. Sign up by calling CVS Caremark at 855-619-9400.
Mail Order and Maintenance Choice: 90-Day Supply

$10 Co-pay
N/A
Generic Preventive
N/A
$20 Co-pay
Generic
$20 after deductible
$20 Co-pay
are your cheapest option – only $10!
$60 Co-pay
$60 Co-pay
Preferred Brand
$60 after deductible
Consumer Choice Advantage
Non-Preferred Brand $150 after deductible $100 Co-pay $100 Co-pay Generic drugs have the same active ingredients as their brand counterparts, but cost less. Co-pays for generic drugs
Generic preventive prescriptions are not subject to the deductible. You can obtain these medications at a low co-pay of
Annual
Out-of-pocket $3,400 / $6,800 $2,000/$4,000 $2,500/$5,000 $5 for a 30-day supply and $10 for a 90-day supply.
Maximum medical and prescriptions prescriptions only prescriptions only
Individual/Family
Managing your Prescriptions
Caremark.com CVS Caremark App
• To register, use your Caremark ID number • Submit refills with barcode scanning
located on your prescription card • Locate network pharmacies using current
Considering the Consumer Choice HSA Plan? • Order prescriptions location or zip code
• Learn how the HSA Plan works by visiting caremark.com/hdhp • Check drugs covered in the plan • Always have an electronic ID card on hand

• Generic preventive prescriptions are not subject to the deductible. You can obtain these medications • Learn about new medications • Access to core pharmacy tools without
at a low co-pay of $5 for a 30-day supply and $10 for a 90-day supply • Set up your communication preferences requiring login and password

• Both medical and prescription costs work towards the deductible and out-of-pocket maximum in the for prescription status updates
HSA medical plan. To obtain the list of qualified medications, visit RockTalk Insider

• Look up what your medications would cost in the deductible phase by visting RockTalk Insider and
clicking on the “HDHP Drug Cost Finder” link found on the Prescription Drug Plan benefit page

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