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Caremark Co-Pays

 
# Drug Tier 34-Day Supply Co-Pays
90-Day Supply Co-Pays
1. Generic drug $10 $20
2. Formulary Brand Drug (when no generic prescribing program alternatives are available)*  $20  $40
3. Non-Formulary Brand Drug (when no generic prescribing program alternatives are available)* $40 $80
4. Bio-Tech Drugs/Specialty Drugs** $50 ** 90-day supplies of bio-tech/specialty drugs are not offered
  Some formulary medications may require a Prior Authorization.

**90-day supply medications (except for Bio-Tech/Specialty Drugs) may be filled at MSU Pharmacies or through CVS/Caremark mail order. 90-day supplies of Bio-Tech/Specialty Drugs are not allowed.

***Some specialty drugs will require step therapy. Step therapy is a type of prior authorization that begins medication for a medical condition with the most cost-effective drug therapy and progresses to other more costly or risky therapies only if necessary.

Please note: Compound medications over $300 will require a Prior Authorization.

Annual Out-of-Pocket Maximum Individual $1000 Family $2000

Please Note:

CDHP with HSA enrollees have different prescription benefits. Prescription drug costs under this plan are subject to plan deductible and coinsurance, and then the total cost is covered after they reach the out-of-pocket maximum. This means that enrollees will pay 100% of prescription costs until they reach their deductible, and once the deductible is met, MSU covers 80% of the costs while enrollees pay 20% coinsurance. Once the out-of-pocket maximum is reached, CDHP enrollees will have prescriptions covered 100%. Also under the CDHP, preventive generic prescription drugs for asthma, cholesterol, diabetes and anti-hypertension are covered at 100% without a deductible or coinsurance (where a generic is available).  

CVS Caremark Customer Service

1-800-565-7105 www.cvscaremark.com

 


 

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