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CVS Caremark is the Prescription Drug administrator for all plans. CVS Caremark is a market leader in mail order, retail, and specialty pharmacy services.
No. You are not required to make a separate election for prescription drug coverage. Your prescription drug coverage is part of your Medical Plan. When you select a Medical Plan option, you will also be enrolled for prescription drug coverage.
For 2025, all medical plan enrollees will receive a consolidated ID card with medical, pharmacy, and Collective Health contact information in late December. Additional ID cards can be ordered at bcbstx.collectivehealth.com and on the Collective Health app. Be sure that your home address in MyHR is correct.
Yes. Make sure to show your ID card to your local retail pharmacist the first time you fill a prescription after receiving the card.
You will need the CVS Caremark ID found on your medical ID card. Go to caremark.com and look for the “Register Now” link. Registering only takes a few minutes and you will have a username and password to access all of your prescription information. If you need help, call 1-800-837-4092.
Save time and money when you manage your medications at caremark.com or with the CVS mobile app. You may check drug costs and coverage with the Check Drug Cost tool both online and in the app, and also do a side-by-side comparison of your medications to see where you could save.
You are not required to fill your prescriptions at a CVS retail store. The CVS Caremark network includes more than 67,000 pharmacies, including Walgreens, Wal-Mart, Target, and others. To find an in-network pharmacy in your area, call 1-800-837-4092 or visit caremark.com. Choosing how to fill your prescription depends on whether you are ordering a short-term or long-term medication:
Log in to your individual account at caremark.com to view the most up-to-date drug list and check the cost of your drug.
There are several ways to start using CVS Caremark Mail Service Pharmacy:
When filling a prescription drug, your payment will vary depending on which Medical Plan option you choose and the type of the prescription drug.
CDHP: If you are enrolled in the CDHP, certain preventive medications you take on an ongoing basis are covered at 100% before the deductible is met. Otherwise, you will pay the full cost of the drug (at the CVS Caremark discounted rate), until you have met your deductible, then you will pay your portion. Remember, you can also use your HSA card to pay for prescriptions.
PPO: You will pay a $150 per person or $300 family deductible for brand-named drugs. After you have met your deductible, you will pay a co-pay. Generic drugs are not subject to the deductible.
Generic drugs are approved by the U.S. Food and Drug Administration and are lower cost equivalents to brand drugs. When available, generics provide the lowest cost option while remaining just as safe and effective as brand drugs.
Preferred brand drugs that are preferred on the prescription plan and are lower in cost than non-preferred drugs. Non-preferred brand drugs are brand medications that are still covered by the plan but are the most costly option.
Please check caremark.com to see if you may have a generic or preferred brand alternative available for your medication.
Most of the time, yes. If you choose to purchase a brand-name drug instead of a generic alternative, you will be responsible for the difference in cost between the brand-name and the generic, in addition to the coinsurance. So generic drugs will cost less most of the time!
Pharmacies will generally give you a generic drug, unless your doctor has asked for a specific brand-name drug. If your doctor has prescribed a brand-name drug (either preferred or non-preferred) when a generic is available, you will pay the difference in cost between the brand-name and generic drug.
To help you save money on prescription costs, ask your doctor if there is a generic alternative that would work for you. If a generic equivalent exists, but you are prescribed a brand-name drug (either preferred or non-preferred), you will have to pay the difference in cost between the brand-name drug and the generic drug.
If you are in the PPO plan, you will pay a $150 per person or $300 family deductible on brand-name drugs before the copay will apply.
For some drugs, a prior authorization from your physician may be required. In these cases, your physician will need to provide proof that the drug being prescribed is the appropriate therapy. Physicians can send prior authorizations to CVS/caremark electronically, via fax or via phone.
For some higher cost drugs, there may be drugs available that are less costly that work the same function as the more costly medication. In these cases, a patient may need to try the lower cost drug before they may “step” to the higher cost medication. Once the member has tried the lower cost drug, they will be able to fill the higher cost drug, if needed.
Quantity limits are usually set for any of the three following reasons: the drug is FDA-approved only for short-term use, it may cause dangerous side effects when overused, or it carries the risk of being inappropriately overused.
In some cases, there may be products that were once only available via prescription, that are now available over the counter. In these cases, our prescription plan would not cover a medication if it is also available over the counter.
Yes. Please see the Benefits Guide to learn about step therapy, prior authorization, and the PrudentRx program for specialty drugs.
If you or your dependents are enrolled in an Energy Transfer medical plan and take a specialty drug covered by the plan, you can enroll in the PrudentRx program. This program helps lower your costs through non-need-based manufacturer copay cards. If a manufacturer copay card is available, you will have a $0 out-of-pocket cost. CDHP enrollees must satisfy their deductible before the $0 copay applies.
You can opt out of the PrudentRx program and pay the rate specified in the Benefits Guide for your medications. Note: If you are enrolled in Medicare Part D or Medicaid, you cannot participate in the Prudent Rx program.
You will receive a welcome letter from PrudentRx with details specific to your medication. You will also be notified if you are required to complete any enrollment steps for the manufacturer. A PrudentRx member advocate will help with any manufacturer enrollment.
If you have questions, you can contact PrudentRx at 1-800-578-4403.
We know that you may have questions about your benefits. We’re here to help you! The Benefit Advocate Center offers you a variety of services. When you have a question, need to file a claim, or search for a doctor, you will reach out to Collective Health.
Have claims or medical plan questions? Collective Health is here to help.
New hires, need help with enrolling in benefits? Contact the Benefit Advocate Center, Monday–Friday, 6 a.m.–8 p.m. CT, Saturday, 9 a.m.–1 p.m. CT.
Download our comprehensive benefits guide to learn more about the available options and how they can benefit you.
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