Prescription Drug Plan
When enrolling in an NYU medical plan, participants automatically receive prescription drug coverage through CVS Caremark. Your CVS Caremark identification card should arrive at your home address within three weeks of a new enrollment.
The cost of medication will depend on the type of drug (i.e., generic, brand-name on the CVS Caremark Performance (Preferred) Drug List (PDF: 519 KB), or brand-name not on the list) as well as whether you fill the prescription through a retail pharmacy or mail order service.
You can save the most money on prescriptions by opting for lower cost generic drugs. You can also save money when you use a brand-name drug on the CVS Caremark Performance (Preferred) Drug List.
Generic drugs are a safe, effective, low-cost option for treating many common conditions. CVS Caremark will dispense a generic medicine, if available, as a substitute for a brand-name medicine when filling your prescriptions. If either you or your doctor request a brand-name medicine when a generic equivalent is available (your doctor may indicate “DAW” or Dispense As Written on the prescription), you will pay the generic drug copay, PLUS the difference in cost between the brand-name and the generic medicine. See a DAW example (Google Doc: 11 KB) for more detail.
The Generic Step Therapy program applies to therapies to treat the following conditions: high blood pressure and cholesterol, acne, prostate, asthma, osteoporosis, pain and inflammation, cholesterol (triglycerides), allergies, glaucoma, stomach/ulcer, migraine, sleep related problems, and incontinence. This program helps you and your doctor choose a lower-cost, generic medicine as the first step in treating these health conditions. If you try (or have tried) a generic drug and it does not work for you, then you may receive coverage for a non-preferred brand drug that your doctor prescribes. If no generic is available – or if it is not right for you – your plan provides coverage for preferred select brand drugs, which may also save you money. However, if you choose to use a non-preferred brand drug without trying a generic first or without your doctor getting prior approval for a non-preferred brand, coverage may be denied and you may have to pay the full cost of the brand drug. CVS Caremark will contact you and your doctor prior to any Step Therapy change. See the Step Therapy FAQs (PDF: 117 KB) for more details.
|*Does not apply to the High Deductible Health Plan.|
CVS Caremark Additional Resources:
|Retail Pharmacy Cost (30-day supply)||Value and Advantage||HDHP + HSA|
|Retail Generic||$10 copay||10% coinsurance after deductible*|
|Brand-name on CVS/Caremark’s Preferred Drug List||$35 copay||10% coinsurance after deductible*|
|Brand-name not on CVS/Caremark’s Preferred Drug List||$55 copay||10% coinsurance after deductible*|
|Maintenance medication filled three or more times||$75 copay||10% coinsurance after deductible*|
|Specialty Medication||30% coinsurance or $0 copay**||10% coinsurance after deductible*|
|Mail Order Cost (90-day supply)||
Value and Advantage
||HDHP + HSA|
|Mail Order Generic||$5 copay||10% coinsurance after decuctible*|
|Brand-name on CVS/Caremark’s Preferred Drug List||$75 copay||10% coinsurance after decuctible*|
|Brand-name not on CVS/Caremark’s Preferred Drug List||$90 copay||10% coinsurance after decuctible*|
* HDHP with HSA Plan: Until the combined medical and prescription drug deductible is met, you will pay the full cost of your non-preventive medical expenses and non-preventive prescription drug expenses. Preventive drugs on the CVS Caremark Preventive Drug Therapy List (PDF: 169 KB) are not subject to the deductible. Coinsurance of 10% will apply.
** Coinsurance of 30% for eligible PrudentRx specialty prescriptions filled at CVS Specialty; $0 when enrolled in PrudentRx. If a member’s specialty medication is not on the PrudentRx list, then the preferred brand copay or the non-preferred brand copay will apply.
If you or your dependent(s) take any maintenance medications regularly (i.e., for three months or more), you are required to fill your prescription through the convenient mail order service to your home. If you choose to fill your maintenance medication at a retail pharmacy, you will be required to pay a $75 copayment on your third and subsequent retail fills. An alternative option is to request that your mail order prescription be delivered to your local CVS pharmacy, rather than your home, through CVS Caremark’s Maintenance Choice program. You may refill a 90-day prescription through Caremark mail service at day 50. You may also receive as much as a 180-day supply at mail service, for the cost of two mail order copays, if your physician will write a prescription for a 180-day supply.
If you use a pharmacy that does not participate in CVS Caremark to fill a prescription, you will pay 100% of the retail price. You will then need to submit a claim form for reimbursement, along with an original prescription receipt. You will only be reimbursed for the cost the plan would have paid had you gone to a network pharmacy (discounted price), less the applicable copay. In most cases, the discounted price will be less than the retail price, so you will end up paying more. You may view a list of network pharmacies at CVS Caremark or call 800-421-5501.