Topic

MSB Employee Benefit: Pharmacy Coverage

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Your Pharmacy Benefit

Prescription drug coverage is administered through CVS Caremark. Your pharmacy benefits work alongside your medical plan and include coverage for many commonly prescribed medications. Your pharmacy benefit helps make prescription medications more affordable and gives you access to a network of participating pharmacies.

What medications are covered on my plan?

Pharmacies and health plans use a drug formulary, which is a list of medications that are covered under the prescription benefit. The formulary identifies which medications are covered, which may require additional review or authorization, and whether lower-cost or preferred alternatives are available. View that CVS Drug Formulary here.

*Please note: while some anti-obesity drugs are covered by CVS, they are not covered by our plan. However, CVS is currently offering partnerships with some manufacturer's coupons. Please discuss with your provider and CVS if this is a therapy being considered.*

Do I have to use CVS to fill my prescription?

No, you are not required to use CVS to fill your prescriptions. However, using CVS is often more cost-effective for both the health plan and for you as a member.

CVS offers both in-store pickup and convenient mail-order delivery options.

They also offer a free maintenance medication program that may allow you to receive up to a 90-day supply of certain medications for the cost of a single 30-day copay.

You can use the CVS Caremark member portal or app to:

• View your prescription benefits

• Look up medications and coverage

• Check prescription costs

• Find participating pharmacies

• View your prescription history

• Manage eligible prescriptions and refills

Prior Authorization & Step Therapy

Some drugs may require:

• Prior authorization (approval before the pharmacy will fill)

• Step therapy (trying a lower-cost drug before a higher-cost drug)

• Quantity limits (federal or plan limits for amount of medication distributed at one time)

Your doctor can help submit these requests.

Need Help?

• Pharmacy Benefit Manager (PBM): call 1-866-818-6911 or visit www.caremark.com.

• HR/Benefits Team: Nicole Kantrowitz, Healthcare Concierge (907) 861-8503