Q: What is the Choices prescription drug program?
One drug program provides coverage for generic and brand-name drugs.
- You can choose to buy generic or name-brand drugs, but you'll save more money when you choose generic medications.
- You can choose to purchase prescription drugs at your local pharmacy or through CVS Caremark's mail-delivery service. You'll save more when you choose mail delivery.
Q: How can I get an estimate?
The cost depends on the medication, whether it's generic or brand name, and if you buy it at a pharmacy or order it through the mail.
You can call CVS Caremark at 1-888-291-6372, or go online to the CVS Caremark Web site (www.caremark.com), to find out what your current prescriptions will cost.
Q: How much will I pay for my drug?
The cost depends on whether it's a generic or brand name medication, and where you buy it.
| | Buy at a retail pharmacy | Buy through mail service | | Generics | You pay 10% of the costs with no deductible, up to the $100 coinsurance maximum
After two maintenance medication refills at the pharmacy, you'll pay an extra 10% (20%) of the costs
The coinsurance maximum ($100) applies to your 10% coinsurance, but not the extra 10% you must pay for maintenance medication refills | Generics are free - you pay nothing! | | Brand 80/20 | You pay 20% of the costs with no deductible, up to the $100 coinsurance maximum
After two maintenance medication refills at the pharmacy, you'll pay an extra 10% (30%) of the costs
The coinsurance maximum ($100) applies to your 20% coinsurance, but not the extra 10% you must pay for maintenance medication refills | You pay 20% of the costs, up to the $200 coinsurance maximum | | | When there is a generic equivalent (same active ingredients as brand drug), you pay: - the generic coinsurance (10% if you go to a pharmacy or 0% if you order through the mail) plus
- the difference in cost between the brand-name and generic drug
Plus, if it's a maintenance medication, after two refills at the pharmacy, you'll pay an extra 10% of the costs
Important: The maximum coinsurance limit ($100 or $200) does not apply toward the extra 10%. There is no maximum for the cost difference | | Brand 50/50 | After the $50 deductible (combined for mail & retail), you pay 50%, up to $100
After two maintenance medication refills at the pharmacy, you'll pay an extra 10% (60%) of the costs
The coinsurance maximum ($100) applies to your 50% coinsurance, but not the extra 10% you must pay for maintenance medication refills | After the $50 deductible (combined for mail & retail), you pay 50%, up to $200 | | | When there is a generic equivalent (same active ingredients as brand drug), you pay: - the generic coinsurance (10% if you go to a pharmacy or 0% if you order through the mail) plus
- the difference in cost between the brand-name and generic drug
Plus, if it's a maintenance medication, after two refills at the pharmacy, you'll pay an extra 10% of the costs.
Important: The maximum coinsurance limit ($100 or $200) does not apply toward the extra 10%. There is no maximum for the cost difference |
Q: What is the difference between a generic alternative and a generic equivalent?
- Generic equivalent: This is a generic that has the exact same active ingredients as the brand-name drug. When a drug patent expires, other companies may produce a generic version of the brand-name drug. A generic medication, also approved by the Federal Drug Administration (FDA), is basically a copy of the brand-name drug and is marketed under its chemical name. A generic may have a different color or shape than the brand name, but it must have the same active ingredients, strength, and dosage form (i.e., pill, liquid, or injection), and provide the same effectiveness and safety. For example, the generic equivalent for Prozac is Fluoxetine.
- Generic alternative: These are generics that are not the exact equivalent of the brand-name drug, but can be used to treat that medical condition. For example, there are generic options to treat cholesterol. Even though there is not yet a generic equivalent for the drug Lipitor, generic alternatives exist to treat the condition.
Q: How do I know if my drug is Brand 80/20 or Brand 50/50?
The easiest way to determine how your medication will be covered by the plan is to contact CVS Caremark. You can call CVS Caremark at 1-888-291-6372, or go online to (www.caremark.com), to find out what your current prescriptions will cost.
Q: How do I know if there is a generic alternative or a generic equivalent?
Talk to your doctor about generics. Explain that you will save a lot of money when you use them. Your doctor will be able to tell you about any options that may be available for you.
Q: If I enroll in the HSA, will I get the free generic drugs through the mail?
For HSA participants, you can take advantage of benefits of the prescription drug plan once you've met the combined medical and prescription drug deductible (IRS Rule). This means until you meet the HSA deductible, you will pay the full cost of your prescription drugs.
Q: Why is Alcoa encouraging me to use generic drugs?
If your physician prescribes a brand-name drug that has a generic equivalent and you would rather have the brand-name, you'll pay the generic coinsurance plus the difference between the costs for the two drugs. Important: The maximum generic coinsurance limit applies. But, there is no maximum for the cost difference in the medications.
For example:
If the brand-name drug costs $100 at retail pharmacy and the generic drug costs $40, you would pay $64:
| The generic coinsurance (10 percent of $40) | = | $4 | Plus difference in cost between brand and generic
($100-$40) | = | $60 | | You pay $4 + $60 | = | $64 |
Q: Are generics as safe and effective as brand-name drugs?
Yes. Like brand-name medicines, generic drugs are rigorously tested and approved by the Food and Drug Administration (FDA) before they can be sold. Manufacturers must prove that generic medications work exactly like their brand-name equivalents. A generic drug is the same as its brand-name equivalent in safety, active ingredients, strength, how it works in the body, and how well it works.
Q: Why did Alcoa decide to single out diabetes and asthma drugs?
Diabetes and asthma are among the most common chronic diseases affecting Alcoa employees and their dependents. Daily management of these conditions often requires the use of brand-name drugs that may not have generic alternatives, and if treatment is not regulated, the individual can become seriously ill very quickly.
Q: Why do I have to pay 10 percent more for my maintenance prescriptions if I don't order them through the mail?
Like many employers, Alcoa is encouraging the use of mail delivery for your maintenance medications because it saves you and the company money. While some employers have mandated the use of mail order for maintenance medications, you still have a choice under Alcoa's plan — but you'll pay more if you purchase your maintenance drugs at a retail pharmacy after two refills. Mail delivery is a safe, convenient way to get the medications you need.
Q: If my doctor is prescribing a medication, what should I ask him to do so I can save the most money when I fill the prescription?
Don't be shy about asking your doctor questions — your doctor understands that you share in the cost of your medications and are looking for ways to save money and manage your health. - Always ask your doctor if there is an appropriate generic version or a less expensive alternative drug available—sometimes there is even an over-the-counter alternative. If your brand-name drug does not have a generic equivalent, ask your doctor if there is a more affordable and effective alternative.
- If you will be taking the medication long-term, request a 30-day prescription that you can take to a retail pharmacy right away and a up to a 90-day prescription with refills that you can use for mail delivery. Remember: you save more on maintenance medications through mail delivery.
- And, finally, ask if there is a treatment that doesn't require medications. Sometimes the best treatment isn't a "magic pill." It's changing your lifestyle.
Q: What if my doctor recommends I use a brand-name drug instead of a generic drug?
If your doctor believes that a brand-name drug is more appropriate for you, he or she can provide medical evidence to CVS Caremark and request authorization for the brand-name drug.
If CVS Caremark approves that request, you'll pay 50 percent of the drug's cost, after the deductible, up to the out-of-pocket maximum. (Although unlikely, it's possible that a brand with a generic equivalent could fall into 80/20 Brand.)
If Caremark does not approve that request, you can still get the brand-name drug, but you'll pay the generic coinsurance plus the difference between the costs for the two drugs. Important: The maximum generic coinsurance limit applies. There is no maximum for the cost difference in the medications.
If the brand-name drug costs $300 at retail pharmacy and the generic drug costs $60, you would pay $246:
| The generic coinsurance (10 percent of $40) | = | $4 | Plus difference in cost between brand and generic
($150-$40) | = | $110 | | You pay $4 + $110 | = | $114 |
Q: What happens if my doctor changes my medication to treat an ongoing problem? Will that count toward my two refills for a maintenance medication?
- Each time your doctor changes your maintenance medication (switches you from Lipitor to Zocor) or changes the strength of your maintenance medication (decreases from 100 mg to 50 mg), you are able to get your prescription filled at the retail pharmacy with two refills. In other words, these changes to your prescription are not applied toward the two refills at your retail pharmacy. However, once your doctor finds the right prescription for you, you should order your maintenance medication through the mail so that you get the highest level of benefits.
- A change in the number of doses you take will not reset the counter. For example, if your doctor changes your prescription from one pill a day to two pills a day, this counts and you will begin be pay 10% more if you continue to get this maintenance medication at a retail pharmacy after two refills.
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