How Your Drug Coverage Works
Here are the basics:
There are three coverage categories: generic, Brand 80/20 and Brand 50/50.
Generics
- If you buy your drug at a pharmacy, you pay 10% and Alcoa pays 90%.
- If you're taking a generic maintenance medication, consider filling it through the mail-order program - then it's free! If you continue to fill a maintenance prescription at your retail pharmacy after the first three fills, you'll pay an extra 10% coinsurance.
Brand 80/20
- If there are no or limited generic alternatives to treat your condition, your brand-name drug is considered Brand 80/20.
- If you buy this drug at a retail pharmacy or through the mail, you pay 20% and Alcoa pays 80%.
- If your drug has a generic equivalent, you pay the generic coinsurance plus the difference in cost between the brand-name and generic drug. The coinsurance maximum applies, but there is no maximum for the difference in cost. To save money, talk to your doctor about generic equivalents.
- If you're taking a maintenance medication, consider filling it through the mail-order program. If you use the retail pharmacy after three fills, you'll pay an extra 10% coinsurance. The coinsurance maximum applies, but not toward the extra 10%. To save money, use this safe and convenient service for filling your maintenance prescription.
- Brand name asthma and diabetes drugs are covered under Brand 80/20. If these drugs have a generic alternatives, you pay the generic coinsurance plus the difference in cost between the brand-name and generic drug. The coinsurance maximum applies, but there is no maximum for the difference in cost.
- Specialty drugs are covered under Brand 80/20, and must be ordered through CVS Caremark's Specialty Drug pharmacy.
Brand 50/50
- If there are an appropriate number of generic alternatives available to treat your condition, your brand-name drug is considered Brand 50/50.
- If you buy this drug at a retail pharmacy or through the mail, you first pay an annual deductible of $50 for an individual and/or $100 for families. After you meet the deductible, you pay 50% and Alcoa pays 50%.
- When your Brand 50/50 drug has a generic equivalent, you pay the generic coinsurance (10% if you go to a pharmacy or nothing if you order through the mail) plus the difference in cost between the brand-name and generic drug. Important: The coinsurance maximum applies, but there is no maximum for the difference in cost. To save money, talk to your doctor about generic equivalents.
- If you're taking a Brand 50/50 maintenance medication, consider filling it through the mail-order program instead of at the pharmacy. If you continue to use the retail pharmacy after three fills, you'll pay an extra 10% coinsurance. The coinsurance maximum applies but not toward the extra 10%. To save money, use this safe and convenient service for filling your maintenance prescription.
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The easiest way to determine your coverage category and what your drug will cost is to contact CVS Caremark at
1-888-291-6372 or www.caremark.com.
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Important for People Using Asthma and Diabetes Drugs
Asthma and diabetes drugs will be paid under the Brand 80/20 category.
- If your drug doesn't have a generic alternative available: You pay 20% coinsurance.
- If your drug does have generic equivalent available: You pay the coinsurance for the generic plus the difference in cost between the brand-name and generic drugs.
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Important for People Using Specialty Drugs
Specialty drugs, including select injectable and oral medications, must be purchased through CVS Caremark Specialty Pharmacy Services. These items will be shipped to you using next day air service.
More information
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