Your Out-of-Pocket Costs
To find out what your prescription drugs will cost, contact CVS Caremark by calling 1-888-291-6372 or by going to www.caremark.com.
General information about your out-of-pocket costs:
- Your annual prescription drug deductible (combined for retail pharmacy and Mail Order) applies only to Brand 50/50 drugs. The deductible is $50 for an individual and $100 for families. (Remember: If you elect the HSA, you must meet the combined medical and prescription drug deductible before the plan begins to pay for drug expenses.)
- After you meet any applicable deductible for your prescription drugs, you pay a coinsurance amount. The amount you pay depends on the coverage category for your drug (generic, Brand 80/20, or Brand 50/50).
- If you use a brand-name drug when a generic equivalent is available, Alcoa pays only the cost that would apply if you chose the generic drug. You pay the generic coinsurance plus the difference in cost between the brand-name and generic drugs.
- If you fill your prescription for a maintenance medication more than three times at your retail pharmacy, you'll pay 10% extra. Avoid the extra costs by using the mail-delivery service, and get your generic maintenance drugs for free!
- The maximum coinsurance you'll pay per fill is $100 at a retail pharmacy or $200 when you use mail delivery. This maximum applies to the coinsurance but does not apply to any extra costs if you choose a brand-name drug over a generic or purchase a maintenance drug at a retail pharmacy instead of by mail delivery.
- If your doctor believes that a brand-name medicine is medically necessary for you instead of the generic equivalent, he or she can provide clinical reasons to the CVS Caremark Prior Authorization Department at 1-888-413-2723. If the brand-name drug is approved, you'll pay the brand-name drug coinsurance.
If You're Enrolled in the HRA, HSA, or FSA
You can use your Health Care Fund FSA (flexible spending account), HRA (health reimbursement arrangement), or HSA (health savings account) money toward these expenses.
- With the HRA and FSA, write Your Spending Account™ card number on the bill (where it says credit card number). Or, you can pay the expense, and file an FSA claim later.
- With the HSA, you can pay by writing a check or using your HSA card.
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