Health and Wellness Banner
  • Prescription Drug Coverage

    Prescription drug coverage is provided as part of enrollment in any of the EMC medical plan options. CVS Caremark administers this benefit for all plans. The following information applies to CVS Caremark coverage.

    Retail Pharmacy: In-Network vs. Out-of-Network

    Prescription Drug ID Cards

    CVS Caremark will send you an ID card within a few weeks of your enrollment in an EMC medical plan option. The card will list only your name (the employee’s). You’ll receive one card if you choose “Employee Only” coverage, or two cards if you elect another coverage level. Request additional cards for dependents through CVS Caremark Customer Care at 855-248-3445 (TDD 800-863-5488).

    You can fill your prescriptions at any pharmacy, but you’ll pay less if you choose a CVS Caremark network pharmacy. The CVS Caremark network is a broad network and is not limited to CVS retail pharmacies. Be sure to visit the CVS Caremark website to find an in-network pharmacy near you. Always show your ID card to the pharmacist when you drop off your prescriptions.

    Mail Order Pharmacy

    If you take a maintenance medication for on ongoing condition such as diabetes, high cholesterol, high blood pressure, or epilepsy, use the CVS Caremark Mail Service Pharmacy to enjoy:

    •  Cost savings. A 90-day supply may cost less than three 30-day supplies at a retail pharmacy.
    •  24/7 access. Talk to pharmacists, and get alert messages by e-mail, text, or phone.
    •  Greater convenience. Enjoy at-home delivery at no extra cost; refill your prescription online or by phone.
    •  Quality and safety. Pharmacists check every order for accuracy.

    If you fill your maintenance medication at a retail pharmacy, beginning with the fourth refill you’ll pay higher out-of-pocket costs, unless you use the CVS Caremark Maintenance Choice program. It allows you to buy your maintenance medication at a CVS retail pharmacy, rather than through the mail, for the same cost as if you received it through mail order. Ask your doctor to write a 90-day prescription. Questions? Contact the CVS Caremark Mail Service Pharmacy at 855-248-3445 (TDD: 800-863-5488). Please note that the Maintenance Choice program does not apply to the BCBS or UHC HSA plan, although HSA plan members do have the option of buying maintenance medications at a CVS retail pharmacy or through CVS mail order.

    Prescription Drug Tiers

    EMC wants to give you the most value for your healthcare dollar. One way we do this is through our prescription drug program, which features a four-tiered approach*. You and your doctor can compare the costs and choose the drug that meets your medical needs and your budget.

    •  Tier 1: EMC Select Generic. Commonly prescribed generic drugs offered at a very low price. Generic medications are sold under their chemical names after the initial patent for the original brand-name drug expires. By law they must have the same active ingredients and are subject to the same rigid FDA standards for quality, strength, and purity as their brand-name counterparts.
    •  Tier 2: Generic. All other generics that are not on the Select Generic list
    •  EMC Preferred Brand (Formulary). A list of commonly prescribed brand-name medications that CVS Caremark considers “preferred” due to their clinical effectiveness and cost.
    •  EMC Brand-Name Non-Formulary (Non-Preferred) Drugs. Brand-name drugs that are not on the plan's formulary of preferred medications. Visit the CVS Caremark website for a list of Non-Formulary medications.

    When you ask your doctor to prescribe formulary medications that are comparable to their non-formulary counterparts, you maintain high quality care for yourself and control your out-of-pocket costs. If you’re currently taking a non-formulary drug, your physician may feel that the comparable formulary drug is appropriate for you. If not, and you wish to continue receiving the non-formulary drug, you can do so, but at a higher out-of-pocket cost.  

    *Prescription benefits for the HSA plan differ and are outlined in the table below.

    Prior Authorization 

    Certain medications or drug quantities may require a review approval or “prior authorization” by CVS Caremark before the plan will cover the expense. Your pharmacist will tell you if this applies to your prescription, or you or your doctor can call CVS Caremark at 800-294-5979. If prior authorization does apply, your doctor will need to send CVS Caremark the required information for review, which can take one to two business days to complete. The review considers FDA-approved prescribing and safety information; clinical guidelines; as well as expert opinion on reasonable, safe, and effective use of the medication.  

    Specialty Medications

    If you are prescribed a specialty medication, you will need to use the CVS Caremark Specialty Pharmacy to receive your specialty medicines. CVS/pharmacy retail stores can accept prescriptions for specialty medications. The prescriptions are transferred to the CVS Caremark Specialty Pharmacy for evaluation, processing, and dispensing. The CVS Caremark Specialty Pharmacy provides your specialty medications as well as personalized pharmacy care management services, including:

    • Access to a team of clinical experts who are trained in your condition
    • Access to a pharmacist who is available 24 hours a day, seven days a week
    • Coordination of care with you and your doctor
    • Convenient delivery to the address of your choice (e.g., your home, your local CVS/pharmacy, your doctor's office, etc.)
    • Medicine- and condition-specific education and counseling
    • Insurance and financial coordination assistance
    • Confidential and empathetic care

    You may access online support and resources at www.CVSCaremarkSpecialtyRX.com, including the specialty pharmacy drug list.  

    What You’ll Pay for Prescription Drugs

    EMC aims to maintain the quality of your prescription drug benefit while keeping your prescription costs as low as possible. The table below shows your cost for prescription drugs, which depends on the drug tier and whether you choose a retail or mail order pharmacy. If you aren’t sure which tier your medication belongs to, call CVS Caremark Customer Care at 855-248-3445 (TDD: 800-863-5488), or visit the CVS Caremark website.

    Prescription Drug Coverage (CVS Caremark)
      Tier 1 Tier 2 Tier 3 Tier 4
      EMC Select Generic EMC Generic EMC Preferred Brand (Formulary) EMC Non-Preferred Brand (Non-Formulary)
    All Plans (Excluding HSA)  
    Annual Deductible None
    Annual Out-of-Pocket Maximum $1,500 individual (up to $3,750 family maximum), retail and mail order combined
     Retail Pharmacy Copay/Coinsurance (30-day supply) $2 copay $10 copay  
      25% coinsurance
    • $25 minimum
    • $50 maximum
     
     
      45% coinsurance
    • $50 minimum
    • $125 maximum
     
     Mail Order Program Copay/Coinsurance* (90-day supply) $5 copay $25 copay  
      25% coinsurance
    • $62.50 minimum
    • $100 maximum
     
     
      45% coinsurance
    • $125
    • $200 maximum
     
    HSA Plan        
      Tier 1
    EMC Generic     
    Tier 2
    EMC Preferred Brand
    Tier 3
    EMC Non-Preferred Brand
     
      10% coinsurance after deductible/30% coinsurance after deductible out of network, retail or mail 10% coinsurance after deductible/30% coinsurance after deductible out of network, retail or mail 10% coinsurance after deductible/30% coinsurance after deductible out of network, retail or mail  

    *Get a 90-day supply of your long-term medication (used to treat ongoing conditions like diabetes or hypertension) by mail. Important note: Under the CVS Caremark Maintenance Choice Program, you may receive your maintenance medication at a CVS retail pharmacy, rather than through the mail, for the same cost as if you received it through mail order. Ask your doctor to write a 90-day prescription.

    CVS Caremark Web Site

    Personalize your health information and manage your prescriptions online at www.caremark.com. Once you register, you can:

    • Order maintenance medication prescriptions through the CVS Caremark Mail Service Pharmacy
    • Track the status of your prescription so you'll know when it's time to reorder
    • Check pricing for brand name and generic medications
    • Learn more about the medications you're taking so you're prepared for your next doctor visit
    • View up to 12 months of detailed prescription history
    • Review personalized health and wellness information
    • Request claim forms
    • View the preferred formulary (CVS Caremark Performance Drug List)
    • Find a retail pharmacy near you, and much more

    For website assistance, call 877-460-7766 (TDD: 800-863-5488).


  • Dispense as Written Program

    When using most pharmacies, including CVS Caremark Mail Service Pharmacy, a generic medicine, if available, will be substituted for a brand-name medicine unless your doctor indicates “Dispense as Written” on the prescription, or you request that only the brand-name medicine be provided.  

    Starting May 1, 2015, if either you or your doctor request a brand-name medicine when a generic equivalent is available, you will pay the generic copay*, plus the difference in cost between the brand-name and the generic medicine. 

    If there is a medical reason that you are unable to use the generic equivalent, your doctor can request an exception to allow the brand medicine to be filled without the additional penalty. Please have your doctor complete this form