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Human Resources

Open Enrollment

CVS Caremark Prescription Benefit Manager

Beginning January 1, 2018 CVS Caremark will manage IU's prescription drug benefit. Many aspects of your prescription benefit will remain the same.

  • Copay/coinsurance amounts will remain the same for the traditional PPO plans.
  • You can still save money with mail order.
  • You will still have the same types of online resources to manage your prescriptions.
  • In most cases, you won’t need to get new prescriptions.

Also, you can still use many of the same pharmacies, not just CVS locations. CVS Caremark pharmacy network includes most retail chain pharmacies, such as CVS, Walmart, Target, and most supermarket pharmacy chains. Some independent pharmacies are included also. However, Walgreens pharmacy is NOT in-network.

Read more about the transition to CVS Caremark (PDF) and use the resources on this page to review and price medications.

FAQs Customer Service

Plan Basics

Price Medications

Anthem PPO HDHP Prescription Coinsurance

Compare Prescription Medication Costs

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
In-Network: member pays 20% after deductible (no deductible on Preventive Rx)
Out-of-Network: Not covered

Anthem PPO $500 Deductible Rx Copays

Compare Prescription Medication Costs

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
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 Plan Coinsurance

Compare Prescription Medication Costs

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

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

Graduate Appointees/Appointed PostDoc Fellows Plan Copays

Compare Prescription Medication Costs

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

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

IU Residents Plan Copays

Compare Prescription Medication Costs

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

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

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

Refills and New Orders

Any retail or mail order prescriptions that you have at the beginning of December that have remaining refills will automatically transition over to CVS Caremark; a new prescriptions will not be needed. You will be able to continue to go to your current retail pharmacy or through mail order online at Caremark.com to refill your existing prescriptions.

However, any medications that are considered controlled substances will not automatically transfer over to CVS Caremark. You will need to contact your doctor and request a new prescription be provided. You will also need to get a new prescription if your current prescription has expired or if there are no refills left.

Be sure to provide your retail pharmacy with your new 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. Additionally, if you had your prescriptions set up with automatic shipping or payment, you will need to set that feature up again.

Mail Order and 90-day Supply at CVS Retail Locations

Mail order is an option for those that would like to get a 90-day supply of medications shipped to their home. If you currently have remaining mail order refills, they will automatically transfer to the CVS mail order option, but you must contact CVS Caremark for your next refill to be processed. You can do this through your account on the CVS Caremark website or by calling CVS Caremark beginning in December.

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.

Any specialty prescriptions that you have at the beginning of December with remaining refills will automatically transition over to CVS Specialty. 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 cessations prescription 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.  

Why did Indiana University switch prescription drug vendors?

The university is part of a state purchasing program for prescriptions, mandated by state law. The law requires universities in Indiana to partner with the State of Indiana for joint purchasing of prescription drug coverage. The plan was put out to bid, and CVS Caremark was selected. The change will bring overall savings to employees and the university with limited disruption to plan participants.

What do I need to know about the change from Express Scripts to CVS Caremark?

Effective January 1, 2018, the pharmacy benefits manager for all IU-sponsored medical plans will transition to CVS Caremark.

Many aspects of your prescription benefit will remain the same:

  • Your copay/coinsurance amounts will remain the same.
  • You can still use many of the same retail pharmacies.
  • You can still save money with mail order (90-day supply of prescriptions).
  • You will still have the same types of online resources available to you to manage your prescriptions.

Added benefits:

  • You can now fill a 90-day supply of your medication at any retail CVS pharmacy location at the same reduced mail order rates.
  • Mental Health medications have been added to the preventive prescription list used for the HDHP plans.

Changes:

  • The drug formulary is changing. The drug formulary is a list of prescription drugs that offer the greatest overall value. Formulary prescription drugs are chosen for their cost, effectiveness, and their safety. If your current medication is not on CVS Caremark’s formulary list, they will send a letter through the mail to your home address on file notifying you of this change and will provide you with further instructions.

Next steps:

  • Watch your mail in December for a welcome kit from CVS Caremark that will explain member benefits and provide instructions on how to take full advantage of all the prescription services available.
  • Watch your mail in December for any letters detailing any formulary disruptions that you will need to be aware of and follow the instructions provided.
  • If you currently have a prescription for a controlled substance, contact your doctor to obtain a new prescription.
  • If your prescription is expired or out of refills, contact your doctor to obtain a new prescription.
  • If you utilize mail order, go online to caremark.com and update your billing and shipping information
  • Be sure to take your new ID card (either the Anthem medical ID card or the CVS Caremark card if you are an IU Health plan member) to your pharmacy to update your plan information.

Is there a change to the prescription drug copayment/coinsurance structure in 2018?

No. The prescription drug copay/coinsurance structure for all medical plans will remain unchanged in 2018.

Will the plan's drug formulary change?

Yes. Beginning January 1, 2018, Indiana University will adopt the CVS Caremark formulary (PDF), which may cause some prescriptions to cost more, or some to cost less. Participants impacted by a change will be notified by CVS by mail. If you are affected by a change, you may want to consult with your healthcare provider to discuss a therapeutic alternative.

Will I still be able to use my network retail pharmacy?

Yes. CVS Caremark's network includes major chain pharmacies and most local independent pharmacies, not just CVS locations.

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.

Will the preventive drug list for the HDHP plans change?

Yes. Beginning January 1, 2018, Indiana University will adopt the CVS Caremark preventive drug list (PDF). If you are affected by a change, you may want to consult with your healthcare provider to discuss a therapeutic alternative.

If I currently have a drug authorization from my physician, will the authorization be valid with CVS Caremark?

Likely. Your Express Scripts (ESI) drug authorizations will transfer to CVS Caremark with the same authorization end date as you had with ESI. Please note that some drugs, such as controlled substances, cannot be transferred even if there are existing refills. For these types of medications, you must obtain a new prescription from your doctor.

Where can I find the cost of my prescriptions?

Use the links below to check the cost of your medication based on your medical plan:

Starting January 1, 2018, visit Caremark.com or download the CVS Caremark app and select "Check Drug Coverage and Cost".

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.

What happens to my existing mail order prescription?

If your mail-order prescription has refills remaining, it will be transferred to CVS Caremark. Though your remaining refills will transfer, you must contact CVS Caremark for your next mail order refill to be processed. You can do this through Caremark.com (you must register at the site before submitting the request) or by calling CVS Caremark at the number listed on your ID card.

You should contact your doctor to obtain a new prescription for the following items:

  • Expired prescriptions
  • No refills remain
  • Drugs considered controlled substances by law (such as Xanax, Ambien, Ritalin, and others)
  • Future-fill prescriptions that have not been processed and or are being held for a future date

 

Customer Service Contacts

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

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

Open Enrollment Help – IU Human Resources 
Customer Care: 812-856-1234
Email:

 

 

Page updated: November 2017

IU Human Resources
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