CMU's Prescription Plan through CVS Caremark Frequently Asked Questions

CMU Choices offers employees the ability to select one of two prescription drug programs or "No Coverage". A prescription drug program must be selected if an employee is enrolled in one of the medical plans. In addition, the level of prescription drug coverage (single, two-person or family) must be the same as that selected under the medical plan. Visit Caremark's home page at:   www.caremark.com  

Q. How are the two prescription drug plans alike and how are they different?

A. The two prescription drug plans, PD 10/20/30 and PD 20/50 are administered by the same vendor: CVS Caremark. The PD 20/50 plan will be closed to new participants effective 7/1/2012.

The PD 10/20/30 has a three-tier co-pay. It is a generic reimbursement program with a 10% co-pay for generic drugs. If you want a formulary list brand drug when no generic is available, you will pay a 20% co-pay. If you want a brand drug when no generic is available and that brand is not on CVS Caremark's Primary/Preferred Drug List, then you will pay a 30% co-pay. This PD 10/20/30 plan maximizes the use of generics. If you want to use a brand drug that has a generic you will pay the applicable brand co-pay of either 20% or 30% plus the difference in cost between the brand drug and the generic equivalent. The PD 10/20/30 has no deductible.

Effective 7/1/2012 the PD 20/50 plan will be closed to those not already enrolled.  The PD 20/50 has a 20% co-pay for all generics and brand names (including brand names labeled DAW) if the brand is on the formulary list. If you want a brand drug that has no generic and that brand is not on CVS Caremark's Primary/Preferred Drug List, even if labeled DAW, then you will pay a 30% co-pay. This plan has a $50 per member and $150 family deductible. The $50.00 deductible is waived if the prescriptions are filled through the CVS Caremark mail order program.

Q. What if I am on the PD 10/20/30 and my doctor writes, "dispense as written" for a $45.00 brand drug which has an existing FDA approved generic equivalent costing $23.00?

A. You will be able to get the brand drug prescribed by your doctor but you will be responsible to pay the cost difference between the brand drug and the generic equivalent plus the applicable brand co-pay on the brand name drug cost.

Example, if brand is not on preferred Rx list:
Brand drug and is not listed on preferred Rx list but has a generic equivalent. The brand cost is $45.00.
Generic cost is $23.00.
Employee will pay cost difference, plus 30% of the brand name drug cost.
$13.50 co-pay + 22.00 difference = $35.50.
Employee pays $35.50.
Example, if brand is on preferred Rx list:
Brand drug is listed on preferred Rx list, but has a generic equivalent. The brand cost is $45.00.
Generic cost is $23.00.
Employee will pay cost difference, plus 20% of the brand name drug cost.
$9.00 co-pay + 22.00 difference = $31.00.
Employee pays $31.00

 If the employee in this example had selected the $23.00 generic the cost would have been a 10% co-pay or $2.30.

The cost saving to you and to the plan is in your use of generic prescription drugs on this PD 10/20/30 plan.

Q. In the prescription drug program, will prescription drug cards be required?

A. Yes, CVS Caremark prescription drug cards will be required. They are issued in the employee's name and are mailed to you when you enroll in the plan. By showing your card at your local network pharmacy you may fill up to or including a 34 day supply or 100 units whichever is greater.  You may fill up to a 90-day supply at CMU's University Health Services Pharmacy (free on-campus delivery). At the point-of-service, you will be required to pay the option co-pay and deductible, if applicable.

Q. Can I receive additional benefit ID cards?

A.  Yes, for additional benefit ID cards, please call CVS Caremark Customer Service representatives toll-free at 1-888-796-8687.

Q. May I fill my prescription at a non-participating pharmacy?

A. There are more than 62,000 participating pharmacies in the CVS Caremark program.  When you choose to go to a non-participating pharmacy, you will pay the full prescription price.  If you use a non-participating pharmacy, you should submit a paper claim form along with the original prescription receipt(s) not a cash register tape for the prescription.  It must include , at minimum, the: patient name, Rx number, total charge, date filled, NDC number, Quantity, days supply, NABP of the pharmacy that filled each prescription, pharmacy name and address.  Paper claims will be paid 365 days from the fill date.  Foreign claims will also be processed by CVS Caremark.  The drug must be covered by the plan and have a U.S. equivalent drug.

Q. What happens if I don't have my prescription card when I go to the pharmacy?

A. You can tell them you have CVS Caremark and give them your social security number and the pharmacist can look up your id number in the CVS Caremark system and adjudicate your prescription claim for you.

Q. What type of drugs will be restricted/excluded from CMU Choices prescription drug program?

A. See the drug exclusion list on the Prescription Drug grid. The exclusions include experimental drugs, appetite suppressants, anorexiants (weight control), any drug not FDA Approved, Rogaine, over-the-counter products, devices and implants, drugs used for cosmetic purposes, and injectable drugs other than insulin. Growth hormones are restricted subject to pre-authorization process.

Q. I heard that University Health Services is offering 3-month refills and on-campus delivery. How do I find out more?

A. Staff and Fixed-Term faculty and their dependents of all ages who have CVS Caremark prescription drug coverage will be able to get a 3-month supply of medications through University Health Services (UHS) for prescriptions taken on a long-term basis. The first time the prescription is filled, a one-month supply will be dispensed to minimize expense in case of a medication or dosage change.  An on-campus delivery service is available; pre-registration is requested in order to establish the customer database. For additional details on this new service call the UHS pharmacy at 989-774-6590.

Q. Why should I use the CVS Caremark Mail Service Pharmacy for my prescriptions?

A. The CVS Caremark Mail Service Pharmacy is a convenient and cost-effective way for you to order up to a 90-day supply of maintenance or long-term medicine.  You can have your long-term medicine delivered to your home, office or a location of your choice with free standard shipping.  By using mail service you minimize trips to the pharmacy while saving money on your prescriptions. More information on the CVS Caremark Mail Service Pharmacy can be found at:  Mail Order

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