Teamsters Western Region & Local 177 | Benefits | Prescription Drugs

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Prescription Drug Benefits

 

Prescription Drug Coverage for Aetna and Blue Cross Blue Shield PPO Participants

CVS Caremark is the Plan’s pharmacy benefit manager and prescription drug plan administrator. The CVS Caremark retail pharmacy network includes most national drugstore chains. These include most national drugstore chains, like Vons Pharmacy, Walgreens Pharmacy and Rite Aid Pharmacy, and more than 9,800 CVS Pharmacy locations, including those in Target stores. And, the network includes many regional drugstore chains and independently-owned pharmacies. Log on to caremark.com starting January 1 to confirm that your current pharmacy is in-network.

 

When you fill a prescription at a network retail pharmacy, you’ll pay a $5 copay. If your doctor prescribes a long-term medication—that is, a medication taken regularly for chronic conditions like high blood pressure, diabetes or high cholesterol, and taken for more than 30 days—you can use CVS Caremark’s mail-order service or (starting April 1, 2020) pick up your prescription at a CVS Pharmacy store. When you do, and you fill a generic prescription, your cost is $0—no copay!

 

Aetna and Blue Cross Blue Shield PPO Plan Prescription Drug Benefits

How the Prescription Drug Plan Pays Benefits
 

In-Network

Out-of-Network

For medication you take up to 30 days (at a retail pharmacy)

  • $5 copay for generic (or brand name, if there’s no generic equivalent)

  • If you fill a maintenance medication at a retail pharmacy more than twice, your copay will increase to 50% of the cost of the medication

  • Reimbursement is based on the Allowed Amount, as if you used an in-network retail pharmacy

  • The Plan pays 75% of the Allowed Amount; you pay 25% plus any amount over the Allowed Amount

For medication you take up to 90 days (by mail order or, starting April 1, 2020, at a retail pharmacy)

$0 copay for generic (or brand name, if there’s no generic equivalent)

Not covered

 

Using the Mail-Order Program

There are three ways you can use the mail-order program for medications you take regularly, long-term, from CVS Caremark:

  • Online: Visit www.caremark.com/startnow
  • By Mail: Mail in the order form included in your member packet, along with your 90‐day prescription.
  • By Phone:Call the number on the back of your CVS Caremark ID card, and they’ll do the work for you.

Mandatory Generics

Prescription drug costs are a key driving factor in the steep rise in health care costs in the U.S. To help manage the Plan’s and your costs while still providing a high-quality prescription drug program, you must fill your prescription using generic drugs. This means that if a generic drug is available, but you choose the brand name instead, you must pay the cost difference between the price of the brand name drug and the generic drug, plus the copay. The exception is if the brand name drug is approved by CVS Caremark as being medically necessary. Research shows that generics work just as well as brand-name drugs. Generic drugs are required by law to have the same active ingredients, strength, dosage form, and route of administration as the brand-name drugs they’re replacing. All generic drug manufacturing, packaging and testing locations must pass the same quality standards as those for brand-name drugs. On average, the cost of a generic drug is 80 to 85% lower than the equivalent brand-name product.

Less Expensive Doesn’t Mean Lower Quality

Generic drug manufacturers can sell their products for a lot less than the equivalent brand name drugs. That’s because they don’t have the same large expenses that brand-name drug manufacturers do. They don’t have to pay for:

  • Costly research to develop a new drug
  • Costly clinical trials required for new drugs before they can be approved for use by the public
  • Advertising, marketing and promotion

Plus, several generic drug manufacturers are often approved to make the same generic drug. This creates competition, often resulting in lower generic drug prices.

Kaiser Permanente HMO Plan Prescription Drug Benefits

How the Kaiser Prescription Drug Plan Pays Benefits

  CALIFORNIA HMO HAWAII HMO

Generic Drugs - Retail Pharmacy

$5 copay for generic (or for brand name, if no generic equivalent), up to a 100-day supply when medically necessary, prescribed by a Plan physician, and obtained at a Kaiser Permanente Plan pharmacy.  No charge for contraceptives

$10 copay for generic for 30-day retail; $20 copay for generic for  90-day mail order (or for brand name, if no generic equivalent ), when medically necessary, prescribed by a Plan physician, and obtained at a Kaiser Permanente Plan pharmacy.

Preferred Brand Drugs - Retail Pharmacy & Mail Order

$5 copay, up to a 100-day supply, when medically necessary, prescribed by a Plan physician, and obtained at a Kaiser Permanente Plan Pharmacy; subject to formulary guidelines.  No Charge for Contraceptives.

$20 copay for 30-day retail; $40 copay for  90-day mail order, when medically necessary, prescribed by a Plan physician, and obtained at a Kaiser Permanente Plan pharmacy.  Certain drugs may be covered at a different cost share.

Non-Preferred Brand - Retail Pharmacy & Mail Order

$5 copay, up to a 100-day supply, when approved through exception process.

$20 copay for 30-day retail; $40 copay for  90-day mail order, when medically necessary, prescribed by a Plan physician, and obtained at a Kaiser Permanente Plan pharmacy.   Certain drugs may be covered at a different cost share.

Specialty Drugs – Retail Pharmacy Only

$5 copay, up to a 30-day supply.

$75 copay, up to a 30-day supply.  No charge for contraceptives in accordance with formulary guidelines.

 FAQs

Why did I receive a personalized letter from CVS Caremark saying my drug would no longer be covered?

A national panel of physicians and pharmacists continually reviews and compares prescription drugs to ensure your drug list includes proven medications to treat every condition. Some drugs may no longer be included when other safe and effective alternatives are available. If you received this letter, talk with your doctor about your 2014 drug list change. To avoid paying the full retail price of your current medication after June 1st, get a new prescription for a safe, effective, covered alternative. List of alternatives, 2019 List

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