34-Day Supply Co-Pays
90-Day Supply Co-Pays
|2.||Formulary Brand Drug (when no generic prescribing program alternatives are available)*||$20||$40|
||Non-Formulary Brand Drug (when no generic prescribing program alternatives are available)*||$40||$80|
|4.||Formulary Brand Drug or Non-Formulary Brand Drug when a direct generic equivalent is available but not selected.*||$10 PLUS 100% of the difference in cost between the brand drug and the direct generic equivalent.||$20 PLUS 100% of the difference in cost between the brand drug and the direct generic equivalent.|
|5.||Formulary Brand Drug or Non-Formulary Brand Drug when a “same class” generic drug is available from the Generic Prescribing Program “Level II” drug list. (Click here for a more detailed description of Generic Prescribing Program Level II drugs.)*||$10 PLUS 100% of the difference in cost between the brand drug and the average cost of all the generics available in the same class of drugs.||$20 PLUS 100% of the difference in cost between the brand drug and the average cost of all the generics available in the same class of drugs.|
|6.||Bio-Tech Drugs/Specialty Drugs**||$50||Effective 7/1/11 90-day supplies of bio-tech/specialty drugs will no longer be offered**|
|Annual Out-of-Pocket Maximum||Individual $1000||Family $2000|
|CVS CVS Caremark Customer Service||1-800-565-7105||www.cvscaremark.com|
Brand-name drugs available under the plan may be affected by the Generic Prescribing Program. This program includes the following provisions:
Level I of the Program: If you or your dependent selects a brand-name prescription drug for which a direct generic equivalent is available, in addition to the generic copay, you will also need to pay the difference in cost between the brand-name drug and the direct generic equivalent that could have been chosen.
Level II of the Program: For certain therapeutic classes of drugs, if you or your dependent choose a brand-name drug for which generic options exist within the same therapeutic class of drugs, in addition to the generic copay, you will also need to pay the difference in cost between the brand-name drug and the average cost of the generic alternatives available in the therapeutic class. The therapeutic classes of drugs impacted by Level II of the program include osteoporosis, nasal steroids, high cholesterol, allergies, sleep problems and GERD/acid reflux. (Effective 7/1/11, migraine medications, blood pressure drugs (ARBs and ACEs) and acne antibiotics will be part of this class of drugs.)
Excluded-Drugs: Under Level I and Level II of the program include: Premarin, Lanoxin, Dilantin, Coumadin and Synthroid.
Exception-Process: In rare cases, some people are unable to use a certain generic drug for documented medical reasons. There is an exception process through CVS Caremark that physicians can use to request an exception if there is a documented medically necessary reason that a patient needs to take a brand medication instead of a generic. There will be no additional charge to you or your physician to file an exception (however, your physician may charge you a fee or copay for their time).
* * “Bio-Tech/Specialty Drugs” will be limited to 34-day supplies (90-day supplies will no longer be available for these drugs). In addition, effective 7/1/11 these types of drug prescriptions can only be filled by the CVS/Caremark Specialty Pharmacy. Rheumatoid arthritis prescriptions are an exception and can continue to be filled in 90-day supplies.