The following list includes commonly asked questions regarding MSU's Prescription Drug Program. We hope this quick reference is helpful. To get answers to other questions, please contact MSU Human Resources Benefits at (517) 353-4434 or toll-free at (800) 353-4434 ext. 0.

Caremark Custom Drug List
Prescription Drug Co-pays
Prescription Drug Supplies and Services
Prescription Drug Enrollment
Filling Prescription

Caremark Custom Drug List

1. I understand changes in Michigan State University’s prescription drug program administered through Caremark includes a drug formulary or drug list. What is that?
2. What is a “4-Tier Drug Program”?
3. Does the Caremark Custom Drug List include the same drugs for both Caremark mail service and retail network pharmacies?
4. Can I continue to purchase a brand drug even though it is not on the Caremark Custom Drug List?
5. Are drugs not on the Caremark Custom Drug List still covered?
6. Are there drugs not covered at all under MSU’s prescription drug plan?
7. My medication was removed from the Caremark Custom Drug List. How will my medication be filled in the future?
8. My medication was removed from the Caremark Custom Drug List. How will my physician(s) know about this change?
9. Why do drugs on the Caremark Custom Drug List change?
10. How can my physician or I find out what drugs are on the Caremark Custom Drug List?
11. What is the difference between brand drugs and generics?

Prescription Drug Enrollment

1. Do I need to enroll in the prescription drug plan if I change health plans?
2. Can I receive additional I.D. cards?

Filling Prescriptions

1. What is the difference between brand drugs and generics?
2. How long does it take for my prescription to arrive by mail?
3. What if I need to take my maintenance medication right away?
4. Can I purchase long-term maintenance medications at a retail pharmacy?
5. How many refills can I get at a retail pharmacy?
6. How do I get my mail service medication if I live somewhere else during the winter?
7. How do I switch my prescription from a non-participating pharmacy to a Caremark participating pharmacy?
8. What if I show my card and the pharmacist indicates I am not and/or my dependents are not eligible for the prescription drug plan?
9. How does my child, who is a student away at college, obtain prescription drugs?

1. I understand that Michigan State University’s prescription drug program administered through Caremark includes a drug formulary or drug list. What is that?

   The most effective way to control drug costs is to use generic drugs. However, for some conditions or participants a generic may not be available or effective. When it is necessary to prescribe a brand drug, there may be several brands available to treat the condition. A drug formulary or Drug List is a list of brand drugs that are more cost effective and offer equal or greater therapeutic value than the other medications generally in the same drug category. The brand name drugs on the Caremark Custom Drug List have been clinically approved by Caremark’s Pharmacy and Therapeutics Committee consisting of physicians and pharmacists from a wide range of medical specialties. The Committee conducts a rigorous clinical analysis to evaluate and select each Caremark Custom Drug List drug for safety, side effects, drug-to-drug interactions and cost effectiveness.

2. What is a 4-tier drug program?
   
   A 4-tier drug program provides prescription coverage at increasing co-pay levels depending on the medication.  Generic drugs are included in the first tier, formulary-brand name drugs are considered second tier, non-formulary brand name drugs make up the third tier and bio-tech drugs are considered forth tier.  If you have any questions regarding what tier a particular drug is covered, please contact Caremark at (800) 565-7105.

3. Does the Caremark Custom Drug List include the same drugs for both Caremark mail service and retail network pharmacies?
   
   Yes, Michigan State University’s prescription drug plan includes only one Caremark Custom Drug List, which is used for both mail service and retail pharmacy prescriptions.
   
   
4. Can I continue to purchase a brand drug even though it is not on the Caremark Custom Drug List?

   You may continue to purchase a drug not on the Caremark Custom Drug List, however, the co-pay for covered drugs is higher. Certain drugs may be excluded from coverage under the plan.

5. Are drugs not on the Caremark Custom Drug List still covered?

   Drugs not on the Caremark Custom Drug List may be covered under your prescription plan with a higher co-pay than generic and Caremark Custom Drug List drugs subject to exclusions in the plan.

6. Are there drugs not covered at all under MSU’s prescription drug plan?
   
   Yes, the MSU prescription drug plan program excludes weight loss, smoking cessation and human growth hormones.

7. My medication was removed from the Caremark Custom Drug List. How will my medication be filled in the future?

   You can still receive a covered drug that is not on the Caremark Custom Drug List, however, you will be required to pay the higher co-pay for the drug. Certain drugs may be excluded from coverage under the plan.

8. My medication was removed from the Caremark Custom Drug List. How will my physician(s) know about this change?

   Physicians are notified of these changes by Caremark. You should also talk with your physician at your next appointment about options that may be more cost effective.

9. Why do drugs on the Caremark Custom Drug List change?

   The Caremark Custom Drug List is periodically modified to provide a cost-effective list of drugs clinically proven to meet patient needs.

10. How can my physician or I find out what drugs are on the Caremark Custom Drug List?

    You can access this list on the Caremark Web site at www.caremark.com or call Caremark at 1-800-565-7105. In addition, MSU Pharmacies can tell you if a prescribed drug is generic, has a generic equivalent or is a brand drug covered by the MSU prescription drug program.
    

Prescription Drug Co-pays

1. What are the co-pays for the MSU 4-tier drug program (up to a 34-day supply)?

   For up to a 34-day supply of medications filled at a Caremark participating retail pharmacy or an MSU pharmacy:

   Participating Caremark Retail Pharmacy	Michigan State University Pharmacy
   $10 co-pay for generic drugs $20 co-pay for brand name drugs on the formulary $40 co-pay for brand name drugs not on the formulary $50 co-pay for bio-tech drugs	$10 co-pay for generic drugs $20 co-pay for brand name drugs on the formulary $40 co-pay for brand drugs not on the formulary $50 co-pay for bio-tech drugs

   
   
2. Are the co-pays the same for prescriptions filled through the Caremark Mail Service (90-day supply)?
   
   No, co-pays for a 90-day supply through mail or the Michigan State University pharmacies, are as follows:

Participating Caremark Mail Service Pharmacy	Michigan State University Pharmacy
$20 co-pay for generic drugs $40 co-pay for brand name drugs on the formulary $80 co-pay for brand name drugs not on the formulary $100 co-pay for bio-tech drugs	$20 co-pay for generic drugs $40 co-pay for brand name drugs on the formulary $80 co-pay for brand name drugs not on the formulary $100 co-pay for bio-tech drugs

3. What is my co-pay if my physician prescribes a brand name drug not on the Caremark Custom Drug List and there are no other Caremark Custom Drug List alternatives?
   
   If there is no alternative, you would pay the $20 co-pay for a brand name not on the formulary for up to a 34-day supply or $40 for a 90-day supply.
   
   
4. I understand there is an annual maximum out-of-pocket (MOOP) of $1,000 per individual or $2,000 per family. How is this applied and tracked? Does this maximum include co-pays for physician office visits and prescriptions?

The annual maximum out-of-pocket (MOOP) limits of $1,000 per individual and $2,000 per family only apply to the prescription drug program. This MOOP does not apply to physician office visits or other co-pays under the PHP or Community Blue health plans. Caremark will track this. When an individual or family MOOP limit is reached, Caremark notifies the pharmacist that no further co-pays are required for that calendar year. We recommend keeping personal records for verification.

5. Do I need to save my receipts in order to be sure I don’t go beyond the $1,000/$2,000 MOOP?

Caremark’s administration system will track all co-pays for you and any family members and apply them toward the MOOP. You may wish to keep the receipts for your records particularly if you participate in the Health Care Spending Account program.

Prescription Drug Supplies and Services

1. Are diabetic supplies covered under the MSU prescription drug program?
   
   Test strips, syringes, lancets and insulin are covered by Caremark.
   
   
2. Are glucose monitors covered under the MSU prescription drug program?
   
   The AccuCheck® Advantage™ glucose monitor is available at no charge through Caremark.
   

Prescription Drug Enrollment

1. Do I need to enroll in the prescription drug plan if I change health plans?

   No, if you are enrolled in any of the MSU health plans, you will automatically be enrolled in the prescription drug plan.

2. Can I receive additional I.D. cards?

   Additional I.D. cards can be obtained by calling Caremark at 1-800-565-7105.

Filling Prescriptions

1. What is the difference between brand drugs and generics?

   Some prescription drugs have two names: the trademark or brand name; and the chemical, or generic name. By law, both brand name drugs and generic drugs must meet the same standards for safety, purity, strength and quality. Many drugs are available in generic form. Generic drugs can save a significant amount of money, both for you and MSU. If you have any questions regarding generic drugs, call Caremark Customer Service at 1-800-565-7105 or talk with your doctor or pharmacist.

2. How long does it take for my prescription to arrive by mail?
   
   You will receive your prescription within 14 calendar days after Caremark receives your order.

3. What if I need to take my maintenance medication right away?

   Ask your doctor for two prescriptions, one for a 34-day supply and one for up to a 90-day supply. Have the 34-day supply filled immediately at a Caremark participating pharmacy and send the 90-day supply prescription to Caremark or use one of the MSU pharmacies to have your 90-day supply prescription filled.

4. Can I purchase long-term maintenance medications at a retail pharmacy?

   Yes, however, you will be required to pay one co-pay for each 34-day supply obtained.

5. How many refills can I get at a retail pharmacy?

   There is no limit on the number of refills you may obtain at a retail pharmacy for medications you will be continuing to use. However, if you use the Caremark Mail Service Program or the MSU pharmacy for long-term medications, you’ll save money.

6. How do I get my mail service medication if I live somewhere else during the winter?

   Caremark’s mail service pharmacy can maintain two addresses for you and your eligible dependents. Simply let Caremark know when you are at your alternate address and they will have your medication sent to that address. You may also wish to contact the MSU Clinical Center pharmacy for information on their mail options at 517-353-4930.

7. How do I switch my prescription from a non-participating pharmacy to a Caremark participating pharmacy?

   Select a Caremark participating pharmacy and tell the pharmacist where your prescription is currently on file. The pharmacist will contact the pharmacy and arrange the transfer for you.

8. What if I show my card and the pharmacist indicates I am not and/or my dependents are not eligible for the prescription drug plan?

   You will need to pay full price for the prescription and call Caremark Customer Service at 1-800-565-7105 to discuss the problem and determine whether the prescription is reimbursable by filing a paper claim.

9. How does my child, who is a student away at college, obtain prescription drugs?
   
   You can obtain additional Caremark ID cards for your eligible children for retail pharmacy services since Caremark has a nation-wide network of Participating Retail Pharmacies. Have your child call Caremark Customer Service at 1-800-565-7105 to locate a participating pharmacy near where he or she lives. They can also locate a pharmacy near them by accessing the Caremark Web site at www.caremark.com. Your children can also use the mail service by obtaining a mail service kit and following the simple instructions. Mail service kits can be obtained from Caremark Customer Service or by contacting MSU Human Resources Benefits at 1-800-353-4434.