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Call 1-800-410-7778 (TTY: 711)

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 for covered generic medications at network pharmacies for up to a 30-day supply
  • Benefits for 90-day supply at CVS Caremark® Mail Service Pharmacy or CVS Pharmacy® - for lower out-of-pocket costs
  • Benefits for your prescriptions when overseas

Mail order pharmacy

Ask your doctor to consider prescribing medications from your Prescription Drug Guide/Formulary when medically appropriate. To help save you money, ask if a generic medication is available.

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 consider prescribing medications from your Prescription Drug Guide/Formulary drug list when medically appropriate. To help save you money, ask if a generic medication is available.
  • Fill your prescriptions at a network pharmacy.
  • Renew prescriptions before you run out of your medication, or ask us about our Auto Refill or Renewal Programs.
  • Provide your MHBP ID card at the pharmacy.
  • 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: MHBP offers a Vaccine Network Pharmacy Program that covers seasonal and non-season vaccines, please refer to Section 5(f) of the official Plan brochure for more details.

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 Generic/Preferred Brand Specialty Drugs† – 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
Up to 90-day supply through mail order or CVS Specialty® Pharmacy $10 copay $80 copay $120 copay 15% of the Plan’s allowance, limited to $425 per prescription
† Specialty drugs are used to treat chronic, complex conditions and typically require special handling and close monitoring. Specialty drugs must be obtained from CVS Specialty® Pharmacy.
 

**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 (Deductible applies)

Generic** – You Pay Preferred Brand Name (Formulary)** – You Pay Non-Preferred Brand Name (non-formulary) ** – You Pay Generic/Preferred Brand Specialty Drugs†** – You Pay
Up to 30-day supply from a network pharmacy $10 copayment* 30% of the Plan’s allowance, limited to $200 per prescription* 50% of the Plan’s allowance, limited to $200 per prescription.* 30% of the Plan’s allowance, limited to $225 per prescription*
Up to 90-day supply through mail order or CVS Specialty® Pharmacy $20 copayment* $80 copayment per prescription* $120 copayment per prescription* 30% of the Plan’s allowance, limited to $425 per prescription*
† Specialty drugs are used to treat chronic, complex conditions and typically require special handling and close monitoring. Specialty drugs must be obtained from CVS® Specialty Pharmacy.
*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.

Value Plan Rx benefits (No deductible applies)

Generic – You Pay Preferred Brand* – You Pay Non-Preferred Brand* – You Pay
Up to 30-day supply from a network pharmacy $10 copay 45% of the Plan’s allowance, limited to $300 per prescription 75% of the Plan’s allowance, limited to $500 per prescription
Up to 90-day supply through mail order $30 copay 45% of the Plan’s allowance, limited to $500 per prescription 75% of the Plan’s allowance, limited to $700 per prescription
*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.

Prescription drug coverage resources

If you are a current MHBP member, please find drug cost for your specific benefit by logging into your Caremark.com account. Prescription claim history and specific plan design is considered when your drug costs are estimated.

Please make sure to review messages on the Coverage and Cost Results page to see “Plan Notes” which outline important plan information that may impact your coverage.

Examples could include the following items that may be shown on the page or under “Plan Notes”

  • PRIOR APPROVAL IS REQUIRED – Medications that require Prior Approval and/or Specialty pricing & network are not a guarantee of coverage
    • When a drug has any exception or prior authorization pathway available under the plan, the calculator will display the drug along with system‑generated messaging, such as “Prior Authorization Required,” and an estimated tier‑based cost. This display reflects the existence of a potential exception pathway only and should not be interpreted as confirmation of coverage.
  • Plan Limitations Exceeded. Examples could include quantity or days supply – Medications that have quantity or other limits
  • NOT COVERED OR MAY NOT BE THE APPROPRIATE REGIMEN as defined by your plan – Medications not covered by the plan

 

Pricing for medications with age or gender specific benefits won't necessarily provide accurate estimates.

Medications that consider prescription fill history, for copay or coinsurance calculations, may not provide accurate estimates.

Please refer to our posted Formulary for covered medications.

Please call CVS/Caremark at 1-866-623-1441 for specific medication questions.

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® Customer Care at 1-866-623-1441 (TTY: 711).

Have questions? We’re here.

Call 1-800-410-7778 (TTY: 711)

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Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). This is a brief description of the features of this MHBP plan. Before making a final decision, please read the Plan’s Federal brochure(s). All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochure. A single annual $52 associate membership fee makes all MHBP plans available to you.

Aetna and CVS Caremark® are part of the CVS Health® family of companies.

Standalone Prescription Drug Plans are offered by SilverScript, a CVS Health company.

Teladoc and Teladoc physicians are independent contractors and are not agents of Aetna. Visit Teladoc.com/Aetna for a complete description of the limitations of Teladoc services. Teladoc, Teladoc Health and the Teladoc Health logo are registered trademarks of Teladoc Health, Inc.

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