Topic
MSB Employee Benefit: Pharmacy Coverage
Prescription Drug Coverage
Prescription Drug Benefit is administered by CVS Caremark.
What's Covered
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Most generic and brand-name medications
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Some specialty medications (for complex conditions)
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Some preventive drugs at low or no cost (per ACA guidelines)
How to Use Your Benefits
- Present your insurance card at the pharmacy.
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Use in-network pharmacies for the best prices.
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Consider mail-order for 90-day supplies (if available).
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Choose generics when possible—they cost less and work the same.
Drug Copay Costs
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Generic: 10% copay (up to maximum co-pay of $75) per prescription
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Brand Name: 20% copay (up to maximum co-pay of $150) per prescription
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Non-Preferred Brand: 30% copay (up to maximum co-pay of $300) per prescription
Deductible is waived for all covered prescriptions.
Formulary (Drug List)
Check the formulary to see if your medication is covered. A formulary is a summary of which medications are covered, which are not and which medications can be used in place of non-covered medications.
Note: Not all drugs on the list are covered for all diagnoses. Coverage depends on your condition and treatment plan.
Prior Authorization & Step Therapy
Some drugs may require:
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Prior authorization (approval before filling)
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Step therapy (trying a lower-cost drug first)
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Quantity limits
Your doctor can help submit these requests.
Need Help?
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Pharmacy Benefit Manager (PBM): call 1-866-818-6911 or visit www.caremark.com .
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HR/Benefits Team: Nicole Kantrowitz, Healthcare Concierge (907) 861-8503