Pharmacy

UnitedHealthcare (HSA PPO or Traditional PPO)

If you are enrolled in the HSA PPO or the Traditional PPO medical plans, your pharmacy benefits are covered under CVS Caremark. Coverage for prescription drugs is included when you enroll in a UnitedHealthcare medical plan. Both the HSA PPO and the Traditional PPO plans have a combined deductible which means that you must meet the annual deductible before the plan pays benefits for prescription drugs. However, if you are enrolled in the HSA PPO plan you may use your HSA to cover the cost of prescription drugs. If you are enrolled in the Traditional PPO plan you may use your GPFSA to cover the cost of prescription drugs.

Generic and brand name prescriptions filled by a retail pharmacy are limited to, up to a 90-day supply. Prescriptions filled through the mail-order program may be up to a 90-day supply. Specialty prescriptions are limited to a 30-day supply through CVS Specialty Pharmacy only.

Pharmacy Plan Details

	In-Network Pharmacy¹	Out-of-Network Pharmacy¹
Retail (30-day supply)² Generic³/Brand⁴/Non-Preferred Brand Name⁵	HSA PPO: 10%/15%/20% after deductible Traditional PPO: 10%/25%/40% after deductible	HSA PPO & Traditional PPO: 50% after deductible
Mail Order (90-day supply)² Generic³/Brand⁴/Non-Preferred Brand Name⁵	HSA PPO: 10%/15%/20% after deductible Traditional PPO: 10%/25%/40% after deductible	HSA PPO & Traditional PPO: Not Covered

¹ Individual deductible and OOP maximum only apply to employees enrolled in Individual tier. Members in dependent tiers must satisfy an aggregate deductible – the health plan doesn’t begin paying benefits until the entire family deductible has been met. Once the entirety of the family deductible has been met, by one family member or a combination of family members, then the cost sharing begins.
² Deductible waived for preventive medications.
³ Generic Medicines: Always ask your doctor if there’s a generic option available. It could save you money.
⁴ Preferred Brand Name Medicines: If a generic is not available or appropriate, ask your doctor to prescribe from the preferred options drug list.
⁵ Non-Preferred Brand Name Medicines: Drugs that are not on the plan’s preferred list will cost more. If a Non-Preferred Brand Name is part of the CVS Caremark Formulary Drug Exclusions, you will be required to pay the full cost, which does not count towards your annual deductible or annual out-of-pocket maximum.

Preventive Drugs

Your pharmacy plan includes Preventive Drugs. Medications on this list are not subject to your deductible. You will only pay the applicable copay/coinsurance for medications on this list. Also listed is a ACA $0 preventive drug list where you do not pay for these preventive drugs or vaccinations based on ACA guidelines.

Non-Specialty Drugs

Review the CVS Performance Drug List and SCF 2023 Updates. This includes a listing of commonly prescribed generics and preferred brands by category, an alphabetic listing of the commonly prescribed generics and preferred brands and formulary excluded medications (not covered under the prescription benefit and do not contribute towards your deductible or out of pocket maximum) and their preferred alternative. Generics should be considered the first line of prescribing. If there is no generic available, there may be more than one brand-name medicine to treat a condition. The preferred categories included should not be considered an all-inclusive list. This list represents brand name products in CAPS, branded generics in upper and lowercase Italics, and generic products in lowercase italics.

Specialty Drugs

Specialty drugs are high-cost prescription medicines used to treat complex, chronic conditions. (Ex: rheumatoid arthritis, multiple sclerosis, cancer, etc.) Just like non-specialty drugs, specialty drugs offer generics and preferred brand medicines. For more information review the CVS Advanced Control Specialty Preferred Drug List. This includes listings of generics and preferred brands, and formulary excluded medications (not covered under the prescription benefit and do not contribute towards your deductible or out of pocket maximum) and their preferred alternative and outlines the indication based formulary for autoimmune products.

Some specialty drugs may qualify for third-party co-payment assistance programs that could lower your out-of-pocket costs. For any such specialty drug where third-party co-payment assistance is used, you will not receive credit toward your out-of-pocket maximum (OOP) or deductible for any co-payment or coinsurance amounts that are applied to a manufacturer coupon or rebate. Visit the HSA PPO or Traditional PPO pages for more information on OOP maximums and annual deductibles.

Formulary Exclusions

Review the CVS Caremark Formulary Drug Exclusions and SCF 2023 updates to see if your current medicine is not included in your plan’s formulary. If you continue taking a drug listed on the CVS Caremark Formulary Drug Exclusions you will be required to pay the full cost, which does not contribute towards your annual deductible or annual out-of-pocket maximum. Ask your doctor to review the generic or preferred brand name alternatives. To check on drug coverage and costs visit the CVS Caremark website or contact your CVS Customer Care team at 1-844-257-4616.

Kaiser HMO CA

Coverage for prescription drugs is included when you enroll in the Kaiser HMO N. CA plan. In general, generic and brand name prescriptions filled at a retail pharmacy are limited to a 30-day supply. Prescriptions filled through the mail order program may be up to a 100-day supply. However, mail order may be reduced to a 30-day supply for specific drugs. If you are enrolled in the GPFSA, you may use it to cover the cost of prescription drugs.

Prescription Plan Details

	In-Network Pharmacy	Out-of-Network Pharmacy
Retail (30-day supply) Generic/Brand/Non-Formulary	$15/$35/$35 co-pay	Not Covered
Mail Order (100-day supply) Generic/Brand/Non-Formulary	$30/$70/$70 co-pay	Not Covered

Kaiser HMO HI

Coverage for prescription drugs is included when you enroll in the Kaiser HMO HI plan. In general, generic and brand name prescriptions filled at a retail pharmacy are limited to a 30-day supply. Prescriptions filled through the mail order program may be up to a 100-day supply. However, mail order may be reduced to a 30-day supply for specific drugs. If you are enrolled in the GPFSA, you may use it to cover the cost of prescription drugs.

Prescription Plan Details

	In-Network Pharmacy	Out-of-Network Pharmacy
Retail (30-day supply) Generic/Brand/Non-Formulary	$10/$35/$35 co-pay $200 co-pay Specialty	Not Covered
Mail Order (100-day supply) Generic/Brand/Non-Formulary	$20/$70/$70 co-pay Specialty Not Covered	Not Covered

Contact Us

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Phone: 1-888-869-2738

CVS Caremark
Phone: 1-844-257-4616
Visit website

CVS Specialty: CVS Specialty Pharmacy | Specialty Pharmacy, Medications, Drugs
Phone: 1-800-237-2767

CVS Caremark Member ID Number

Looking for your CVS Caremark member ID number? It’s your Workday employee number. Just log into Workday [VMware network access required] and your employee number is next to your name.