MSU Human Resources >> Benefits >> Prescription Drug Plan

Prescription Drug Plan

The prescription drug plan is administered through CVS/caremark. Employees are automatically enrolled for prescription drug coverage in CVS/caremark when they enroll in one of the health plans (Community Blue PPO, Blue Care Network (BCN) or CDHP with HSA).

Co-Pays

Coverage & Eligibility Information

Prescription Drug Program FAQ

MSU Health Team Pharmacy

Prescription Reimbursement Claim Form

Visit the CVS/Caremark Web Site

Effective January 1, 2016, the Generic Prescribing Program was eliminated and MSU began following the CVS/caremark Standard Formulary 1 process. 

 What is not changing?

  • 90-Day supply of medications (except for Bio-Tech Specialty Drugs) are still available through MSU Pharmacies or through CVS/caremark mail order.

  • The “dispense as written” pricing penalty will still apply.  A pricing penalty is applied when a

    • Direct generic equivalent is available but not selected or

    • Generic equivalent in the same class of Drugs is available, but not selected.

Members are responsible for paying their co-pays plus a pricing penalty. Please see https://www.hr.msu.edu/benefits/healthcare/CaremarkCopay.htm for more information about the out-of-pocket expense.   

 What is changing? 

  • The Exception Process for the Generic Prescribing Program was eliminated

  • Some formulary medications may require prior-authorization

  • Co-pay levels will be based on the CVS/caremark Standard Formulary Drug List. To verify coverage and check costs select one of the following links:

Standard MSU Plan 

CDHP plans

  • Step therapy is required for specific therapeutic classes under the Advanced Control Specialty Formulary. The 12 specialty classes are:
    • Autoimmune
    • CML
    • Fertility
    • Hematology
    • Hepatitis C
    • Growth Hormone
    • Multiple Sclerosis
    • Osteoarthritis
    • Osteoporosis
    • Prostate Cancer
    • Pulmonary Arterial Hypertension
    • Transplant
  • Refills for medications after 1/01/16 are subject to the new process. Authorizations granted prior to 1/01/16 will still be honored through the approved end date.   

  • Some drugs are no longer on the formulary list that will be excluded as of 1/01/16.  Options may be available at a lower cost.

  • The Exception Process has changed for requesting a pricing penalty override. This process must be initiated by your physician. The form is available on the CVS/caremark website: http://www.caremark.com/. Employees need to create an account to access the form. 

1 A drug formulary is a list of prescription drugs, both generic and brand name, used by practitioners to identify drugs that offer the greatest overall value. A committee of physicians, nurse practitioners, and pharmacists maintain the formulary.


 

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