2011 Prescription Drug Plan Your prescription drug benefit program is administered by CVS Caremark (Caremark) – the nation’s largest independent provider of health improvement services. Your Choices
If you are enrolled in any of the District medical plan options, you are eligible for prescription drug coverage. When you need prescription drugs, you must use:
Retail Pharmacy Program
Participating pharmacies have agreed to be part of Caremark’s retail pharmacy network. To locate a participating retail pharmacy in your area, access the Pharmacy Locator on or call Caremark at 1-800-378-8651. You must use a network pharmacy to receive plan benefits. The plan doesn’t cover prescriptions purchased at out-of-network pharmacies.
The retail pharmacy program is typically for the purchase of short-term use medications that you need to purchase immediately, such as antibiotics or certain pain medications. You may receive up to a 30-day supply of medication at a time. You must present your Caremark ID card to the pharmacist when purchasing a prescription. Your Aetna ID card can also be used for prescription drugs. The amount of your copayment depends on whether you purchase generic, formulary brand, or non- formulary brand drugs. Ask your doctor to consider prescribing a generic drug whenever possible since you can get the same quality as a brand-name drug at a lower cost.
Caremark Mail Service Program
program can save you money i you have a condition that requires maintenance medication, if you take
regular medication, or you have a long-term illness. Through this program, you may purchase up to a 90-day supply of most prescribed medications. The amount of your copayment again depends on whether you purchase generic, prefer
brand, or non-preferred brand drugs. Your copayments apply to each prescription you and your dependents purchase.
The first time you are prescribed a medication, ask your doctor for two prescriptions, one for a long-term supply (up to 90 days) and another for immediate use (up to 30 days). You can fill the short-term prescription at a participating retail pharmacy and send in the long-term prescription to the mail order program.
Caremark Maintenance Choice Program
For long-term and maintenance medications, the Maintenance Choice program allows you to receive a 90-day supply of your medication in two ways – either through the CVS Caremark Mail Service Pharmacy (online, by phone or through m il
or at a CVS pharmacy near you. No matter which option you choose, your copay remains the same.
You can still get two 30-day supplies of your medication at any network retail pharmacy for the retail copay but after that, you will have to pay the mail copay to receive either a 30-day supply (non-CVS retail store) or a 90-day supply (CVS retail location or mail order).
What is Covered
The amount you pay for prescription drug coverage depends on whether you purchase generic, formulary brand, or non- formulary brand-name drugs. Your copayments apply to each prescription you and your dependents purchase.
2011 Prescription Drug Benefits Through Caremark
Consumer Plus (Limited and Plan Features Choice)* Consumer Basic (Limited and Choice)*
(retail, 30-day supply) Non-formulary, Brand Name
(mail order, 90-day supply)** Formulary, Brand Name
(mail order 90-day supply) Non-formulary, Brand Name
Plan Features Open Access
(retail, 30-day supply) Non-formulary, Brand Name
(mail order, 90-day supply)** Formulary, Brand Name
(mail order 90-day supply) Non-formulary, Brand Name
(mail order, 90-day supply) * Individual annual deductible of $50 at all delivery systems.
Generic drugs will be dispensed whenever possible. Brand-name drugs will be dispensed only when there is no equivalent generic drug available for substitution. If a brand drug is filled when a generic is available, you will pay the brand copay plus the difference in the cost between the generic and the brand name drug.
Waived Generic Copays
The HISD prescription drug plan provides generic drugs for hyperlipidemia, hyp
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2011 Prescription Drug Plan