Short Term Medications

Fill at any Pharmacy within Plan Network/Cost for up to 30-day supply after deductible.

Long-Term Medications

Fill at CVS Pharmacy or CareMark Mail Service Pharmacy; Cost for up to a 90-day supply after deductible.

Generic Medications

Best option to save money

$6 for one 30 Day Supply

Preferred Brand-Name Medications

30% ($35 min/$95 max)

For one 30- Day Supply

Non-Preferred Brand-Name Medications

40% ($60 min/$130)

For one 30-Day Supply

Refill Limit

ONE initial fill plus 2 refills for long-term medications.

Specialty Medications

Per 30-day supply of specialty medicines through CVS Specialty Pharmacy:

$60 for generic specialty medicines.

$85 for preferred brand specialty medicines.

$125 for non-preferred brand specialty medicines.

Annual Deductible

$50 per individual/ $100 per family (applies to brand-name medications only)