Your prescription drug coverage will be provided by Caremark and is automatically included with the Aetna Choice POS II Plan.
• Prescriptions for preventive drugs and oral contraceptives are covered at 100%.
• Purchase up to a 30-day supply at a participating retail pharmacy (for short-term prescriptions), or
• Purchase up to a 90-day supply through the mail-order program (for long-term or maintenance prescriptions).
• Through the CVS 90 Program, you can receive a 90-day supply of medication at your local CVS pharmacy and still pay the mail-order copay.
RETIREE COSTS FOR PRESCRIPTION DRUGS*
Preventive Medications $0 (Plan pays 100%)
Oral Contraceptives $0 (Plan pays 100%)
Retail Participating Pharmacy Copay (30-day supply)
– Generic $10 copay
– Brand Formulary 30% of the total cost of the drug ($30 minimum; $75 maximum)**
– Brand Non-Formulary 50% of the total cost of the drug ($50 minimum; $100 maximum)**
Mail-Order & CVS Pharmacies Copay (90-day supply)
– Generic $20 copay
– Brand Formulary 30% ($60 minimum; $150 maximum)
– Brand Non-Formulary 50% ($100 minimum; $200 maximum)
Annual Prescription Drug Out-of-Pocket Maximum (individual/family) $3,000/$6,000
* Retail prescriptions are filled for a 30-day supply; mail order or prescriptions filled at a CVS pharmacy are filled for up to a 90-day supply.
** Your copay and/or coinsurance applies toward the prescription drug out-of-pocket maximum.
To find a participating retail pharmacy, visit www.caremark.com.
Whether you fill your prescription at a retail pharmacy or through the mail-order program, if you elect the brand-name drug when a generic equivalent is available (rather than your doctor prescribing the brand name on the prescription), the plan will pay at the generic-brand level only. You will pay the difference between the cost of the brand-name drug and the generic drug, plus the applicable coinsurance.
How Prescription Drug Coverage Works: An Example
Let’s say you are covered by the POS II Plan and you purchase a brand-name formulary prescription drug that costs $180 for a 30-day supply at an in-network pharmacy. The plan will pay 70% of the cost of the prescription and you will pay 30%, up to a $75 maximum. That means you would pay $54 (30% of the cost for the prescription drug). Now, let’s say you purchase another prescription that costs $370. Although 30% of $370 is $111, you will pay no more than the $75 maximum. And remember that you can save a lot of money by asking your pharmacist if a generic equivalent is available.
