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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.

Mail order and Retail pharmacy information

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.
Find a Network Pharmacy

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. 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.

**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*
*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)
 
**Specialty drugs are used to treat chronic, complex conditions and typically require special handling and close monitoring. 

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
*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)
 
**Specialty drugs are used to treat chronic, complex conditions and typically require special handling and close monitoring. 

Prescription drug coverage resources

Value Plan Cost Calculator

Standard Option Cost Calculator

Standard Option (Medicare A&B Primary) Cost Calculator

Consumer Option Self Only Cost Calculator

Consumer Option Self and Family Cost Calculator

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.

Formulary Exclusion Drug List

Prescription Drug Guide/Formulary

Advanced Control Specialty Formulary

  • For help with any of these prescription drug resources, please call CVS Caremark at 1-866-623-1441 (TTY: 711).

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©2024 Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna). Aetna providers are independent contractors and are not agents of Aetna. Provider participation may change without notice.

This is a summary of the MHBP plan options. Before making a final decision, please read the Official Plan Brochure (RI 71-007 or RI 71-016). All benefits are subject to the definitions, limitations, and exclusions set forth in the official plan brochures. A single annual $52 associate membership fee makes all MHBP plans available to you.