Prescription Drugs

When you choose an ITW medical plan, you automatically get prescription drug coverage through CVS Caremark.

Overview

You can go to a retail pharmacy for your short-term medication needs (such as antibiotics). You can fill long-term or maintenance medications (such as insulin or blood pressure medication) only twice at a retail pharmacy. After that, you’ll need to fill them using Maintenance Choice (in person at CVS retail pharmacies) or mail order (through CVS Caremark).

If you fill a brand-name drug when a less expensive generic alternative is available, you’ll pay the difference between the cost of the brand name and the generic plus your copayment or coinsurance. But if your doctor believes that a generic option isn’t right for you, he or she can submit medical documentation to CVS Caremark and request approval to use a brand-name drug. If the request is approved, you will not have to pay the additional cost.

All three plans will cover generic preventive medications at no cost. The chart below shows what you pay to fill other prescriptions.

 

What You Pay to Fill Prescriptions

 HealthSaverPPO1 and PPO2
Retail (up to a 30-day supply)
Preventive GenericNo cost to youNo cost to you
Generic20% after the medical deductible$15 copayment (or cost of prescription if less)
Preferred Brand20% after the medical deductible25% (up to $100)
Non-Preferred Brand20% after the medical deductible40% (up to $200)
Mail Order (up to a 90-day supply)/Maintenance Choice (90-day supply)
Preventive GenericNo cost to youNo cost to you
Generic20% after the medical deductible$30 copayment (or cost of prescription if less)
Preferred Brand20% after the medical deductible25% (up to $250)
Non-Preferred Brand20% after the medical deductible40% (up to $450)
Specialty (up to a 30-day supply)
Generic or Brand20% after the medical deductible$0 (if enrolled in the PrudentRx Copay Program) or 30% (if not enrolled in the program)
Annual Prescription Drug Out-of-Pocket Maximum
IndividualIncluded in medical out-of-pocket maximum$2,500
FamilyIncluded in medical out-of-pocket maximum$5,000

PrudentRx Copay Program

Employees and their family members with specialty prescription drugs — generally high-cost medications used to treat complex, chronic or rare conditions — who are enrolled in the PPO1 or PPO2 medical plan can take advantage of the PrudentRx Copay Program and get their specialty prescriptions for $0. PrudentRx will reach out to you if you are taking a specialty medication to enroll you in the program. If you don’t join the program, you’ll pay 30% of the cost for the same medication.

 

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