Drug Card Plans

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Drug Card plans make it easy for members to get the prescriptions they need. When members use a network pharmacy, they don’t have to file claims or wait for reimbursement. The pharmacist uses a computer to check their benefits and find out the amount they must pay. Members pay the lower of the pharmacy’s price, our special discounted price, or the copayment or coinsurance that applies to their prescriptions.

With most Drug Card plans, the amount members owe is based on their drug's status on our Preferred Drug List and on their plan's benefits. Most Drug Card plans are divided into three tiers. Members pay the copayment or coinsurance amount that applies to their drug’s tier. Tier 1 drugs are generic drugs. Tier 2 drugs are preferred brand-name drugs. Tier 3 drugs are non-preferred and will usually cost members more. To find the tier for a drug, enter the drug's name in the drug lookup tool. (This link leads to a third party website. Caremark, an independent company, is solely responsible for the contents and privacy policy on its site.)

Some Drug Card plans also combine the amounts members pay for their prescriptions with the amounts they pay for any medical care they receive. When members satisfy their deductibles, the pharmacy will collect any copayment or coinsurance due from them. When they satisfy their out-of-pocket maximum, they will no longer pay for prescriptions for the remainder of the plan year. If we administer their Health Reimbursement Accounts, we may submit their claims for reimbursement, depending on their benefits.

Members should use a network pharmacy whenever possible and always show their ID cards. Depending on the benefit plan, we may only reimburse members who don’t use a network pharmacy or show their ID card the amount we would have paid at a network pharmacy, even if they paid more than the network pharmacy price. Members will also have to complete a prescription drug claim form and attach their prescription receipt(s) in order to receive reimbursement.