Prescription benefits overview
Prescription and pharmacy benefits information
Your medicine is important
All MHBP plans include comprehensive prescription drug coverage. And offer tools and guidance to help you find covered medicine and understand your costs.
This means you can get access to nationwide network pharmacies, low copays for generic medications and mail-order pharmacy services. Our prescription drug plans offer tools and guidance to help you find covered medicine and understand your costs.
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Make the best choices for your health and budget no matter which MHBP plan option you have
- Nationwide access to network pharmacies
- Low co-payments at network pharmacies for up to a 30-day supply of covered generic medications
- 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.
- Coverage for most FDA-approved medications
Mail order pharmacy
MHBP offers mail order pharmacy benefits for prescription drugs that you take on an on-going basis. You may also order your prescriptions by mail, internet or phone.
Prescription benefits
All MHBP plans include comprehensive prescription drug coverage.
Tips for using your prescription benefits:
- Ask your doctor to prescribe medications that work for your needs and that are also easy on your budget. Ask if a generic medication is available to help save you money.
- Fill your prescriptions at a network pharmacy.
- Renew prescriptions before you run out of your medication.
- Provide your MHBP ID card at the pharmacy.
- Bring a copy of the Prescription Drug Guide/Formulary to your next doctor visit to help your doctor choose an appropriate medication.
- Use Vaccine Network pharmacies to get your flu shot and other covered immunizations — you’ll pay nothing.
Remember: Certain drugs require preauthorization. Current listings of these drugs are available below. Refer to Section 5(f) of the official Plan brochure for more details on your prescription drug coverage.
*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.
Talk to a nurse anytime
Nurses are available to answer general medication questions at no cost to you anytime at 1-800-556-1555 (TTY: 711). Select the option to speak to a nurse.
Standard Option Rx benefits (No deductible applies)
Generic – You Pay | Preferred Brand** – You Pay | Non-Preferred Brand** – You Pay | Specialty Drugs † – You Pay | 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 $225 per prescription | Tier cost share of contracted rate and difference between contracted rate and billed amount |
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 | N/A- not covered |
**Specialty drugs are used to treat chronic, complex conditions and typically require special handling and close monitoring.
Consumer Option Rx benefits (Deductible applies)
Generic – You Pay | Preferred Brand Name (Formulary)** – You Pay | Non-Preferred Brand Name (non-formulary) ** – You Pay | Non-Network Pharmacies – You Pay | CVS Caremark Specialty Pharmacy | |
---|---|---|---|---|---|
Up to 30-day supply from a network pharmacy | $10 copayment | 30% of the Plan’s allowance and any difference between our allowance and the cost of a generic equivalent unless a brand exception is obtained, limited to $200 per prescription* | 50% of the Plan’s allowance and any difference between our allowance and the cost of a generic equivalent unless a brand exception is obtained, limited to $200 per prescription.* | All Charges | 30% of the Plan’s allowance, limited to $225 per prescription |
Up to 90-day supply through mail order | $20 copayment* | $80 copayment per prescription and any difference between our allowance and the cost of a generic equivalent unless a brand exception is obtained* | $120 copayment per prescription and any difference between our allowance and the cost of a generic equivalent unless a brand exception is obtained* | All Charges | 30% of the Plan’s allowance, limited to $425 per prescription* |
Value Plan Rx benefits (No deductible applies)
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 |
Prescription drug coverage resources
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.
- Cost-effective – You save money when you choose generic drugs over brand-name 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.
- For help with any of these prescription drug resources, please call CVS Caremark at 1-866-623-1441 (TTY: 711).
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