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.
Overview of Plan-Specific Pharmacy Benefits
All MHBP plans include comprehensive prescription drug coverage. This means you can get 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
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 $200 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.
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 |
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 | |
---|---|---|---|---|---|
Annual Deductible | Annual Deductible* | Annual Deductible* | Annual Deductible* | Annual Deductible* | Annual Deductible* |
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 | 20% of the Plan’s allowance, limited to $200 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 | 20% of the Plan’s allowance, limited to $425 per prescription |
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.
- 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.
To select “Find a Network Pharmacy” above. Or you can call 1-866-623-1441 (TTY: 711).
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
CVS Caremark® Mail Service Pharmacy Website
Prescription Drug Guides:
Advanced Control Specialty Formulary
Prescription Drug Guide/Formulary
MHBP Prior Authorization Listings:
Caremark Prescription Drug 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
For help with any of these prescription drug resources, please call CVS Caremark at 1-866-623-1441 (TTY:711).
Have Questions? Call 1-800-410-7778
24 hours a day, 7 days a week, except major holidays