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Prescription Benefits

MHBP knows how important prescription drug coverage and pharmacy benefits are—so we’ve got you covered! No matter which MHBP option you have, you'll have:

  • Nationwide access to network pharmacies
  • Coverage for most FDA-approved medications
  • Low co-payments at network pharmacies for up to a 30-day supply of covered generic medications (Consumer Option members must meet your annual deductible first)
  • Benefits for mail-order pharmacy to save you even more money—and get up to a 90-day supply
  • Network benefits for your prescriptions when overseas.
  • Access to savings on everyday health-care related items through the CVS Caremark ExtraCare® Health Card program.

Overview of Plan-Specific Pharmacy Benefits

All MHBP plans include comprehensive prescription drug coverage with access to nationwide network pharmacies, low copays for generic medications, and mail-order pharmacy services. Below is a plan-by-plan comparison of our prescription drug coverage and pharmacy benefits along with the out-of-pocket costs for prescription drugs under each plan.

Standard Option Prescription Drug Coverage and Benefits

Standard Option Rx Benefits (No deductible applies)
Generic - You Pay Preferred Brand** - You Pay Non-Preferred Brand** - You Pay Specialty Drugs † - You Pay All Covered Rx—Non-Network and Paper Claims - You Pay
Up to 30-day supply from a network pharmacy $5 copay 30% of the Plan's allowance, limited to $200 per prescription 50% of the Plan's allowance, limited to $200 per prescription 15% of the Plan's allowance, limited to $200 per prescription *50%
Up to 90-day supply through mail order (Caremark for Specialty) $10 copay $80 copay $120 copay 15% of the Plan's allowance, limited to $425 per prescription All charges

† Specialty drugs are used to treat chronic, complex conditions and typically require special handling and close monitoring. Specialty drugs must be obtained from CVS Caremark Specialty Pharmacy.

*50% of the Plan's allowance and any difference between our allowance and the billed amount. This does not apply to Specialty drugs.

** You will pay the copayment or coinsurance amount and the difference in cost between our allowance for the generic and brand name drug when a generic is available, unless a brand exception is obtained.

Value Plan Prescription Drug Coverage and Benefits
Generic - You Pay Preferred Brand* - You Pay Non-Preferred Brand* - You Pay All Covered Rx—Non-Network Provider and Paper Claims - You Pay
Up to 30-day supply from a network pharmacy $10 copay 45% of the Plan's allowance 75% of the Plan's allowance All charges
Up to 90-day supply through mail order $30 copay 45% of the Plan's allowance 75% of the Plan's allowance All charges

*You will pay the copayment or coinsurance amount and the difference in cost between our allowance for the generic and brand name drug when a generic is available, unless a brand exception is obtained. Value Plan Rx Benefits (No deductible applies)

Consumer Option Prescription Drug Coverage and Benefits
Generic - You Pay Preferred Brand** - You Pay Non-Preferred Brand** - You Pay Non-Network Provider and Paper Claims - You Pay
Annual Deductible Annual Deductible* Annual Deductible* Annual Deductible* Annual Deductible*
Up to 30-day supply from a network pharmacy $10 copay $25 copay $40 copay Not Covered
Up to 90-day supply through mail order $20 copay $50 copay $80 copay Not Covered

*The annual deductible of $2,000 per person/$4,000 per family for medical and Rx expenses combined applies to all services except preventive care.

**You will pay the copayment or coinsurance amount and the difference in cost between our allowance for the generic and brand name drug when a generic is available, unless a brand exception is obtained.Consumer Option Rx Benefits (Annual deductible applies)

Choosing Generic Medications - Are Generic Drugs Really as Good as Brand Names?

You might wonder if generic drugs are as good as brand-name ones. Like many, you might think that generic drugs are lower in quality and not as effective as brand-name drugs. This is not true. Generic drugs are:

  • Safe and effective - The U.S. Food and Drug Administration (FDA) holds generic drugs to the same standard as their brand-name alternative. They must have the same active ingredients, be equivalent in strength and dosage, and meet the same standards for safety, purity and effectiveness as the original brand-name product.
  • Equal quality - The FDA strictly regulates generic drugs just as they do with brand-name drugs. Before the FDA will approve a generic drug, it must pass a number of stringent tests and trials to ensure that is can be used in place of a specific brand-name drug.
  • Cost-effective - You save money when you choose generic drugs over brand-name drugs.
  • Commonly used - About 44% of all prescriptions in the U.S. are filled with generic drugs.

The fact is, generic drugs work just as well as brand-name drugs, but cost less. And generics are available for many brand-name drugs. So when you need a new prescription, ask your doctor if a generic equivalent can be prescribed.

MHBP Generic Drug Incentive Program

You may be eligible for the Generic Drug Incentive program if you are currently taking a non-generic medication and switch to a generic replacement for that drug. If you qualify, you can receive a one-time, up to a 90-day, supply of the generic drug at no cost to you from a network retail pharmacy or by mail order. You’ll receive a letter from CVS Caremark if you qualify for this program.

Find a Network Pharmacy

To locate a participating network pharmacy or find a flu vaccine network pharmacy, click on the link above. Or you can call 866-623-1441.

Please note: The flu vaccine network covers the influenza vaccine only. The pharmacist will administer the vaccine at the store. Vaccine administration by a pharmacist can vary by state. Please make sure that your selected flu vaccine network pharmacy is permitted to provide this service.

MHBP Prescription Drug Coverage Resources

Caremark Mail Order Website

Prescription Drug Guides:

View Specialty Drug List

View All Other Drugs List

MHBP Prior Authorization Listings:

Medical Necessity Drug Listing 2017

Specialty Prescription Drug Listing >>

Prior Authorization Drug Listing >>

Caremark Prescription Drug Cost Calculator:

Value Plan Cost Calculator >>

Standard Option Cost Calculator >>

Consumer Option Self Only Cost Calculator >>

Consumer Option Self and Family Cost Calculator >>

For help with any of these prescription drug resources, please call CVS/caremark at 866-623-1441.

 
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