CVScaremark
TM
WANT TO
SAVE MORE?
You can contact
RxBenefits at
1-800-334-8134 for
alternative ways you
can save money.
?
HELPFUL INFO
Benefit Videos
CVS/Caremark's
Mail Order Service
Livongo
PreferredChoice
Network Participating
Retail Pharmacies
Plan Document
PrudentRX
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OVERVIEW OF PRESCRIPTION INSURANCE
Cary offers prescription (Rx) insurance through RxBenefits/CVS Caremark. This benefit is
included in both of Cary's medical plan options; there is no additional cost per paycheck for
this benefit. The amount you will pay for your medication is based on the medical plan you
enroll in.
MEDICAL – TRADITIONAL PLAN (PPO)
On this plan, you will either receive your medication(s) for free (generic or specialty) or you
will pay a copay. The amount you pay goes toward an out-of-pocket maximum of $1,500 for
an individual and $3,000 for a family. The chart below shows your cost per tier:
30 DAY SUPPLY AT RETAIL 90 DAY SUPPLY (MAIL ORDER OR CVS)
Generic/Tier 1 $0 $0
Preferred Brand/Tier 2 $25 $50
Non-Preferred Brand/Tier 3 $50 $100
Specialty/Tier 4 $0 N/A
You must enroll in the PrudentRx program for your specialty medications to be $0. Call
1-800-578-4403 to enroll.
MEDICAL — HIGH DEDUCTIBLE HEALTH PLAN (HDHP)
You are responsible for the full cost of the medication, except for federally mandated
medications. The amount you pay goes towards the same out-of-pocket as your medical
out-of-pocket, which is $3,200 for an individual and $6,400 for a family.
30 DAY SUPPLY AT RETAIL 90 DAY SUPPLY (MAIL ORDER OR CVS)
Generic/Tier 1 100% after deductible 100% after deductible
Preferred Brand/Tier 2 100% after deductible 100% after deductible
Non-Preferred Brand/Tier 3 100% after deductible 100% after deductible
Specialty/Tier 4 100% after deductible 100% after deductible
MORE INFORMATION
Your RxBenefits are accepted at most pharmacies nationwide, but if you would like to
receive full advantage of the benefits available to you, choose one of these PreferredChoice
Network Participating Retail Pharmacies.
Page 12 CARY Benefits Handbook
Prescription Insurance
