Human Resources

CVS Caremark (retail and mail order prescriptions)

Prices for medications may vary based on which pharmacy you use, the quantity of your medication (30-day or 90-day), and the use of brands versus generics. You’re encouraged to log in to your Caremark account to check the price of your medications before having them filled. All prescription cost shares apply toward your medical plan’s out-of-pocket maximum.

Retail (up to 90-day supply)

• In-Network: member pays 20% after deductible.
• Out-of-Network: You can submit a claim form and receipt to CVS Caremark for potential reimbursement. The amount reimbursed will be equal to the CVS Caremark price or the purchase price (less any member cost-share), whichever is lowest. Approved claims will count towards your annual in-network deductible and out-of-pocket maximum.

Mail Order (up to 90-day supply)

• In-Network: member pays 20% after deductible.
• Out-of-Network: Not covered.

Medications on the No-Cost Preventive Drug List are covered by the plan 100%.

Medications on the HDHP Preventive Drug List are covered with a 20% coinsurance and no deductible.

Check drug costs for this plan

Archimedes (specialty medications)

If you use a manufacturer copay assistance program to reduce your out-of-pocket cost for a specialty drug, only the actual amount you pay will count towards your health plan’s deductible and out-of-pocket maximum.

Specialty Medications (up to 30-day supply)

• In-Network: member pays 20% after deductible.
• Out-of-Network: Not covered.

CVS Caremark (retail and mail order prescriptions)

If you request a brand drug when a generic is available, you will be responsible for paying the generic drug copay plus the cost difference between the brand and the generic. In-network prescriptions have a separate out-of-pocket maximum from the medical plan. For 2025, it is $6,800 per member / $11,200 family maximum.

In-Network:

Retail (up to 30-day supply)

• $8 generic (Tier 1)
• $25 preferred brands (Tier 2)
• $45 non-preferred brands (Tier 3)
• Non-Covered Drugs (with network discount) – Member pays 100%

Retail or Mail Order (31 to 90-day supply)

• $20 generic (Tier 1)
• $62 preferred brands (Tier 2)
• $112 non-preferred brands (Tier 3)
• Non-Covered Drugs (with network discount) – Member pays 100%

Out-of-Network:

Retail: 50% coinsurance (plus amounts above the network’s discounted price )

Mail Order: Not Covered

Medications on the No-Cost Preventive Drug List are covered by the plan 100%.

Check drug costs for this plan

Archimedes (specialty medications)

Specialty Medications (up to 30-day supply)

If you use a manufacturer copay assistance program to reduce your out-of-pocket cost for a specialty drug, only the actual amount you pay will count towards your health plan’s deductible and out-of-pocket maximum.

• $20 generic (Tier 1)
• $62 preferred brands (Tier 2)
• $112 non-preferred brands (Tier 3)

CVS Caremark (retail and mail order prescriptions)

If you request a brand drug when a generic is available, you will be responsible for paying the generic drug copay plus the cost difference between the brand and the generic. In-network prescriptions have a separate out-of-pocket maximum from the medical plan. For 2025, it is $7,400 per member / $13,000 family maximum.

In-Network:

Retail (up to 30-day supply)

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

Retail or Mail Order (31 to  90-day supply)

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

Out-of-Network:

• Retail: 50% coinsurance (plus amounts above the network’s discounted price
• Mail Order: Not Covered

Medications on the No Cost Share Medication List are covered by the plan 100%.

Check drug costs for this plan

Archimedes (specialty medications)

Specialty Medications (up to 30-day supply)

• $150 copay

If you use a manufacturer copay assistance program to reduce your out-of-pocket cost for a specialty drug, only the actual amount you pay will count towards your health plan’s deductible and out-of-pocket maximum.