PrescriptioN Drugs

ALL MEDICAL COVERAGE OPTIONS INCLUDE PRESCRIPTION DRUG COVERAGE.

Coverage is through CVS Caremark, except where Kaiser Permanente and HMSA are the carriers. Coverage includes a:

  • Retail program (up to a 30-day supply): For short-term medications obtained at a CVS Caremark network pharmacy (includes pharmacies other than CVS retail pharmacies).
  • Mail-order program or CVS retail pharmacy (up to a 90-day supply): Only for long-term or maintenance medications filled through the mail-order program or at any CVS retail pharmacy.
  • Specialty prescriptions program (up to a 30-day supply): Medications must be filled through mail-order or at a CVS retail pharmacy beginning with the first prescription. The PrudentRx Copay Program is also available through CVS Caremark for covered specialty prescriptions. By opting into this program, you don’t pay for certain covered specialty medications after you meet your applicable deductible requirement.

You can fill an initial prescription for a long-term maintenance medication (one that you need for more than 60 days), plus one refill, at any in-network retail pharmacy. After that, you’re required to refill that prescription through CVS Caremark’s mail-order program or at a CVS retail location.

Retail pharmacy (up to a 30-day supply)

Non-preventive drugs (amounts apply after you satisfy the deductible)

  • Generic drugs: You pay a $10 copay
  • Preferred brand drugs: You pay 30% ($25 min/$75 max)*
  • Non-preferred brand drugs: You pay 40% ($50 min/$100 max)*

Mail-order or CVS retail pharmacy (up to a 90-day supply)

Non-preventive drugs (amounts apply after you satisfy the deductible)

  • Generic drugs: You pay a $25 copay
  • Preferred brand drugs: You pay 30% ($62.50 min/$187.50 max)*
  • Non-preferred brand drugs: You pay 40% ($125 min/$250 max)*

Note: The cost-sharing amounts above apply after you satisfy the deductible, except under the $500 Deductible coverage option (there’s no deductible for prescription drug coverage under this option so cost sharing applies immediately).*

Preventive drugs that are classified as preventive under the Affordable Care Act are covered at 100%, with no deductible requirement. For other preventive drugs, you pay the non-preventive amounts shown above (deductible doesn't apply).

* If you choose a brand-name drug that isn’t excluded from coverage and has a generic equivalent, you’ll pay the generic drug copay, plus the full difference between the generic and brand-name drug’s cost. This rule applies to prescriptions you receive at a network pharmacy and through mail-order.

Through the PrudentRx Copay Program, you can receive covered specialty medications at no cost after you meet your applicable deductible requirement (when filled at CVS Specialty®). If you or your covered dependent are receiving covered specialty medications, PrudentRx will send you additional details—including how to affirmatively enroll in the program. If you don’t enroll, a PrudentRx Advocate will reach out to you directly with more information regarding your options.

If you don’t participate in the PrudentRx Copay Program, you’ll pay a 30% coinsurance for any covered specialty medication. In addition, even if your medication is considered an “essential health benefit,” the coinsurance you’ll pay will only apply to your coverage option’s applicable out-of-pocket maximum.

Questions? Contact CVS Caremark, or call PrudentRx at 1-800-578-4403 (representatives are available Monday through Friday, 7:00 a.m. to 7:00 p.m., Central Time).

Rx Savings Solutions (RxSS) is designed to help you save money on your medications and make switching to a lower-cost prescription easy. RxSS is integrated into your prescription drug coverage through CVS Caremark. It doesn’t replace or change your coverage. It’s simply an additional voluntary tool that offers confidential personalized suggestions and cost-saving opportunities given your specific prescription needs. With RxSS, you can:

  • Access Cost-Saving Alternatives: RxSS pharmacists identify equally effective, lower-cost medication alternatives that are covered by your MDLZ-sponsored prescription drug coverage. These alternatives can include a generic option, taking your medication in a different form (i.e., capsule-tablet, ointment-cream, etc.), or using an alternative pharmacy that can fill your prescription at a lower price.
  • Manage and Compare Costs: Once you activate your RxSS account, you can view your options and compare prices. Your account also lists the medications you’ve already filled, making it easy for you to manage everything from one place.
  • Receive Alerts and Notifications: RxSS contacts you via email, direct mail, or a text message when you’re spending too much on current medications or regarding any new ones you may be prescribed in the future.
  • Learn About Your Options: Have a conversation with RxSS's concierge team and/or utilize RxSS's mobile/web-based app to learn about your personalized savings opportunities. RxSS has a team of certified pharmacy technicians ready to help you start saving.
  • Easily Switch to Lower-Cost Medications: If you decide to switch to a more affordable prescription option, RxSS coordinates with your doctor to get their approval beforehand. RxSS then works with your pharmacy to make sure your prescription-switch request is completed.
  • Share Access with Covered Family Members: They too can activate their own account and manage their prescribed medications.

How to Activate Your Account

Go to myrxss.com. You may find these step-by-step instructions helpful.

How to Access Rx Savings Solutions:

  • By Phone: Call 1-800-268-4476. Connect with an experienced pharmacy technician who can answer your questions and facilitate a prescription switch on your behalf.
  • By App: Access your personalized prescription portal from your mobile device or computer at rxsavingssolutions.com. Here, you can learn all about your savings opportunities, view real-time pricing for all covered medications, search for alternative pharmacies, and initiate a prescription switch.
from your mobile device to download the mobile app.

If you need additional help, email support@rxss.com or call 1-800-268-4476. You can also get answers to more frequently asked questions at myrxss.com/faq.

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Questions about how a specific prescription drug is covered?

Call CVS Caremark at 1-888-771-7267. You can also access online preventive and formulary drug lists through the CVS Caremark website. Please note that only drugs on the formulary listing are covered.