CVS Caremark Prescription Benefit Manager

CVS caremark manages IU's prescription drug benefit. You can use Caremark.com or the Caremark app to create a CVS caremark account, which will allow you to:

  • Locate a participating pharmacy
  • Check drug prices and generic alternatives
  • View the drug formulary and preventive drug list
  • Request mail order refills quickly and conveniently
  • View prescription history
  • Check drug interactions
  • Contact a pharmacist

The CVS Caremark pharmacy network includes most retail chain pharmacies, such as CVS, Walmart, Target, and most supermarket pharmacy chains. Some independent pharmacies are included as well. However, Walgreens pharmacy is NOT in-network.

FAQs Customer Service Resources & Forms

Plan Basics

Copays / Coinsurance

Anthem PPO HDHP Prescription Coinsurance

Retail (up to 30-day supply)
In-Network: member pays 20% after deductible (no deductible on Preventive Rx)
Out-of-Network: member pays 40% after deductible

Retail at CVS Pharmacy (up to 90-day supply)
In-Network: member pays 20% after deductible (no deductible on Preventive Rx)
Mail Order (up to 90-day supply) and 
Specialty 
(up to 30-day supply)
In-Network: member pays 20% after deductible (no deductible on Preventive Rx)
Out-of-Network: Not covered

Anthem PPO $500 Deductible Rx Copays

Retail (up to 30-day supply)
In-Network:

  • $8 - Tier 1 – generic (For brand with a generic available, member pays generic copayment and cost difference between brand and generic.)
  • $25 - Tier 2 – preferred brands
  • $45 - Tier 3 – non-preferred brands
  • Non-Covered Drugs (with Network Discount) – Member pays 100%

Out-of-Network:

  • 50% coinsurance plus amounts above the network’s discounted price

Retail at CVS Pharmacy (up to 90-day supply)
In-Network:

  • $20 - Tier 1 – generic (For brand with a generic available, member pays generic copayment and cost difference between brand and generic.)
  • $62 - Tier 2 – preferred brands
  • $112 - Tier 3 – non-preferred brands
  • Non-Covered Drugs (with Network Discount) – Member pays 100%

Mail Order (up to 90-day supply) and
Specialty
(up to 30-day supply)
In-Network:

  • $20 - Tier 1 – generic (For brand with a generic available, member pays generic copayment and cost difference between brand and generic.)
  • $62 - Tier 2 – preferred brands
  • $112 - Tier 3 – non-preferred brands
  • Non-Covered Drugs (with Network Discount) – Member pays 100%

Out-of-Network: Not covered

IU Health HDHP Coinsurance

Retail (up to 30-day supply)

  • In-Network: member pays 20% after deductible (no deductible on Preventive Rx)
  • Out-of-Network: no coverage

Retail at CVS Pharmacy (up to 90-day supply)

  • In-Network: member pays 20% after deductible (no deductible on Preventive Rx)

Mail Order (up to 90-day supply) and 
Specialty 
(up to 30-day supply)

  • In-Network: member pays 20% after deductible (no deductible on Preventive Rx)
  • Out-of-Network: no coverage

Graduate Appointees/Appointed PostDoc Fellows Plan Copays

Retail (up to 30-day supply)

  • $8 generic
  • $25 preferred brands
  • $45 non-preferred brands

Retail at CVS Pharmacy (up to 90-day supply)

  • $20 generic
  • $62 preferred brands
  • $112 non-preferred brands

Mail Order (up to 90-day supply) and 
Specialty 
(up to 30-day supply)

  • $20 generic
  • $62 preferred brands
  • $112 non-preferred brand

IU Residents Plan Copays

Retail (up to 30-day supply)

  • $10 generic
  • $25 preferred brands
  • $75 non-preferred brands

Retail at CVS Pharmacy (up to 90-day supply)

  • $25 generic
  • $60 preferred brands
  • $180 non-preferred brands

Mail Order (up to 90-day supply) and 
Specialty 
(up to 30-day supply)

  • $25 generic
  • $60 preferred brands
  • $180 non-preferred brand

Non-Covered Drugs (with Network Discount) – Member pays 100%

Create an account at Caremark.com to view personalized drug prices based on your plan’s copay/coinsurance structure and your remaining deductible.

Refills and New Orders

Any prescriptions that you have can be filled at a retail pharmacy for a 30-day supply; at a retail CVS pharmacy for a 90-day supply or through mail-order for a 90-day supply.

Be sure to provide your retail pharmacy with your prescription card information so that they can process the claim through CVS Caremark. If you use mail order, you will need to create an online account at Caremark.com or use the Caremark app to update your shipping preferences and billing information.

Mail Order and 90-day Supply at CVS Retail Locations

A 90-day supply of medications can usually be purchased for less than it would cost to buy three 30-day supplies of that same medication at a retail pharmacy.

Mail order is an option for those that would like to get a 90-day supply of medications shipped to their home.

You can do this through your account on the CVS Caremark website, by calling CVS Caremark, or using the Caremark app and scanning the bar codes or qr codes on your mail service prescriptions to request your refills.

Additionally, CVS offers a 90-day supply you can pick-up at CVS retail locations for certain maintenance medications. Maintenance medications are commonly used to treat chronic conditions and taken daily over a long period of time. You can receive the benefit of a 90-day supply and mail order pricing for medications on the CVS Caremark Maintenance Drug List.  The option for a 90-day supply at retail is only offered at retail CVS locations.

Specialty Medications

Specialty medications are drugs that are used to treat complex conditions, such as cancer, growth hormone deficiency, hemophilia, hepatitis C, immune deficiency, multiple sclerosis, and rheumatoid arthritis. CVS Caremark has a separate arrangement for specialty medications to be provided through CVS Specialty. CVS Specialty must be used to fill specialty drug prescription orders, subject to a 30-day supply with the applicable coinsurance or copayment.

You will need to get a new prescription if your current prescription has expired or if there are no refills left. For new specialty prescriptions you can ask your doctor to e-prescribe by calling 800-237-2767 or fax to 800-323-2445.

Medications with No Cost Share

IU employee medical plans cover 100 percent of the cost of certain medications for all IU-sponsored plans according to ACA guidelines.  This includes tobacco cessation prescriptions and over-the-counter tobacco replacement products. Coverage is limited to a 180-day supply per covered individual per year. Covered prescriptions drugs include Chantix, Zyban (bupropion), and Nicotrol. Over-the-counter products require a prescription in order to be covered under the employee's medical plan.  Additionally, certain medications, OTC vitamins, and immunizations are covered with no cost share.  For a full list, along with criteria for coverage, see the No Cost Share Medication List (PDF).

 

Frequently Asked Questions

Below are answers to the most frequently asked questions regarding the Prescription program.  

Where can I find a network pharmacy?

The CVS Caremark pharmacy network includes most retail chain pharmacies, such as CVS, Walmart, Target, and most supermarket pharmacy chains. Some independent pharmacies are also included. However, Walgreens pharmacy is NOT in-network. Visit the CVS Caremark Pharmacy Locator to find a network pharmacy near you.

Where can I find the cost of my prescriptions?

Create an account at Caremark.com to view personalized drug prices based on your plan’s copay/coinsurance structure and your remaining deductible.

What are preventive prescriptions?

If you're in a high deductible health plan (Anthem PPO HDHP or IU Health HDHP) you do not need to meet a deductible for preventive prescriptions. Instead, for all medications on the Preventive Drug List (PDF) you’ll only pay 20% of the cost. This no-deductible preventive drug list not only saves you money but is an important step in preventing more serious health issues in the future. Check specific drug costs on Caremark.com.

What options are available for lowering and/or containing my medication costs?

There are several options available:

  • Talk with your pharmacist or physician about generic and formulary brand name drug alternatives to determine if a less expensive alternative is available. Generic Drugs are required by law to have the same active ingredients, dosage, form, and strength as their brand-name equivalents, but they generally cost less.
  • Talk to your pharmacist/provider about less expensive therapeutic equivalent medications.
  • Switch from a 30-day to 90-day supply. This option is especially beneficial for those with chronic conditions who might be taking multiple medications. CVS Caremark has both a mail order option and an option to get a 90-day supply at retail when using a CVS pharmacy.

Customer Service Contacts

CVS Caremark
Member Services: 866-234-6952
www.Caremark.com

CVS Specialty: 800-237-2767
www.CVSspecialty.com

IU Human Resources 
Customer Care: 812-856-1234
Email:

Resources & Forms

2018 IU Prescription Plan Booklet (PDF)

Drug Formulary (PDF)

Specialty Medications (PDF)

HDHP Preventive Rx List (PDF)

No Cost Share Medication List (PDF)

Allergy Prescription Reimbursement Claim Form (PDF)

Prescription Reimbursement Claim Form (PDF)

Prescription Drug Mail Service Order Form (PDF)