Prescription Coverage


Overview

Eligible State employees automatically receive prescription coverage when they enroll in one of the State's medical plans. Coverage is effective on the first day of state employment.

Coverage Details

Prescription Coverage

Coverage is administered by CVS Caremark. You can fill short-term medications at any of the 68,000 participating pharmacies—including 7,500 CVS/pharmacy locations—nationwide, while you can fill maintenance medications via the Maintenance Choice program or at any participating retail pharmacy by opting out of the Maintenance Choice program (see below).

  • See the Summary of Coverage or contact CVS Caremark for details regarding your prescription coverage.
  • If you are enrolled in the Choice Plus Plan with HSA, you will be required to pay the full cost for your medications until you reach your annual plan deductible. After you meet the deductible, you pay only the co-pay. However, this deductible rule does not apply if you take medications on the Preventive Medication Therapy List—you pay only the copay for these medications even if you have not yet met your deductible.
  • The State plan covers a variety of preventive prescriptions and products at no cost to you and any covered dependents. See CVS Caremark® Preventive Services List for complete detail on what is covered. (Note: Your doctor must write a prescription for these preventive services to be covered by your plan, even if they are listed as over-the-counter.)
Maintenance Choice (with opt-out)

Starting January 2017, you are automatically enrolled in the Maintenance Choice program, where you can save money by obtaining 90-day supply of maintenance medications for the price of 60-day co-pay. (This program does not apply to short-term/acute medications.)

You are not required to use CVS/pharmacy to fill your maintenance medications. If you want to fill 30-day supplies of your maintenance medications at your preferred non-CVS pharmacy, you can opt out of the program by contacting CVS Customer Care at 1-800-307-5432.

To obtain a 90-day supply of maintenance medications:

You are recommended to always use pharmacies within your network. To obtain reimbursement for out-of-network prescription claims, complete the CVS Caremark Rx Claim Form and submit as instructed on the form.

Drug Formularies

A drug formulary is a list of prescription drugs, both generic and brand name, that are preferred by your health plan. See below for the CVS Caremark drug formularies, effective January 1, 2018. Visit CVS Caremark for the most up-to-date formularies.

Check Your Prescription Cost

Find out how much your prescription would cost under your health plan via the CVS Caremark Check Drug Cost Tool:

You are automatically enrolled in prescription coverage when you enroll in one of the State's medical plans. Please see Medical Coverage for more information on eligibility, the enrollment/waiver process, and premium rates.

Please contact CVS Caremark if you have questions regarding your prescription coverage: