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).
Effective January 1, 2016, the Generic Prescribing Program was eliminated and MSU began following the CVS/caremark Standard Formulary
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
- Step therapy is required for specific therapeutic classes under the Advanced Control Specialty Formulary. The 12 specialty classes are:
- Hepatitis C
- Growth Hormone
- Multiple Sclerosis
- Prostate Cancer
- Pulmonary Arterial Hypertension
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.
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.