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CVS Caremark - Rx Benefits

Save Time and Money

“Is my medication covered and how much will it cost?” 

This is one of the most common questions – find the answer quickly with the helpful tools below.

Rx Benefit Summary

Check Drug Cost and Coverage

Prescription Savings Opportunities

Pharmacy Locator
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Prior Authorizations

 

 


 

Please see the Summary Plan Description for more information on coordinating your prescription drug benefit

 

Your Rx Benefit Summary

Under your Maintenance Choice Plan, prescriptions for long-term medications (used to treat conditions like diabetes, asthma, or high blood pressure) must be filled in 90-day supplies at CVS Pharmacy or by mail.

Explain SummaryAfter two fills if you fill these prescriptions in 30-day supplies or at any other pharmacy, your medications won't be covered and you'll have to pay the entire cost.

Specialty medications must be filled at CVS Specialty pharmacy from the initial fill. Prescriptions for short-term medications (like antibiotics) can be filled at any retail pharmacy in network.   

For more information on CVS Specialty and the cost saving program PrudentRX, click here to learn more.

 

CVS Caremark Rx Claim Form

Get reimbursed for prescription drug claims. This includes submitting prescription receipts for secondary coverage to CVS Caremark.

 

RX Benefit Summary

- Calendar Year Deductible

Active Plan $75 person/$150 family

Active Plan $75 person/$150 family

- Supply Per Prescription or Refill

Up to 30 days

Up to 90 days

Generic Medication

Best option to help you save money

$10 or 10% (Higher of)

$20 or 10% (Higher of);
max copay is $50/prescription

Preferred Brand-Name Medications

Best option when a generic isn't available

$25 or 25% (Higher of)

$50 or 25% (Higher of);
max copay is $125/prescription

Non-Preferred Brand Name

Highest cost option

$40 or 40% (Higher of)

$100 or 40% (Higher of);
max copay is $300/prescription

  • In addition to the maximum copays listed above, if you receive a brand name drug when a generic exists, you will pay the difference in cost between the generic and brand name medication.

 

  • Generic preventive services medications, including contraceptives, are covered at 100 percent with no deductible or copay.
  • In addition to the maximum copays listed above, if you receive a brand name drug when a generic exists, you will pay the difference in cost between the generic and brand name medication.

 

  • Generic preventive services medications, including contraceptives, are covered at 100 percent with no deductible or copay.
- Specialty Medications

Enrolled in PrudentRX

$0 Copay

0 Copay

Generic (not enrolled in PrudentRX)

30%

30%

Preferred Brand (not enrolled in PrudentRX)

30%

30%

Non-Preferred Brand (not enrolled in PrudentRX)

30%

30%


Check Drug Cost and Coverage

Enter the drug name, choose your prescribed amount and search. You'll be able to see how much your medication costs, as well as any other options your plan covers, like a generic.

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Active Plan

 


Rx tools to help you saveformulary

Keeping your medication affordable is important. One way we can help is by showing you ways to save on your Rx. Sign in or register to see your personalized savings options.

Know what's covered

Find alternatives that are covered under your plan to save

Next quarter's performance drug list (PDF)

 

 

Check for Savings

Click the savings icon to review a list of personalized savings – just for you. We’ll even send an email alert every time a new savings opportunity comes up. 

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Rx cost savings

 


Pharmacy Locator

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Click pharmacy icon

 

    


dual specialty              

$0 for Specialty Medication

As part of your prescription plan, you will be automatically enrolled in the PrudentRx Copay Program, which allows you to pay $0 out of pocket for any specialty medications on the Specialty Drug List when you fill at CVS Specialty.