Retail Prescription Drugs
Retail prescription drug benefits under the Trust Prescription Drug Plan are administered by CVS Caremark networks. When you need a prescription filled for immediate treatment of an illness or injury, you may use a participating pharmacy or any other pharmacy.
If You Use Participating Retail Pharmacies
When you go to a participating or CVS Caremark network pharmacy, simply show your prescription drug ID card, which identifies you as a CVS Caremark member. You will pay the following copayments:
Copayments at Participating Retail Pharmacies
If you are enrolled in this medical plan:
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Your retail pharmacy prescription drug copayments are:
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Full-Time/Part-Time Option 1:
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Providence Personal Option Plan, Trust Preferred Provider Plan (Regence)
You may purchase up to 90-day supply
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Providence Personal Option Plan, Trust Indemnity Plan (Regence)
You may purchase up to 90-day supply
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Providence Personal Option Plan
You may purchase a 90-day supply
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Automatic Generic Substitution
If a CVS Caremark network pharmacy charges you the full retail cost of a prescription (for example, if you don't have your ID card with you at the time of purchase), or if you agree to be billed instead of paying a copayment, you'll need to file a claim form to receive a benefit. Your benefit will be the in-network charge minus the copayment.
Unless your doctor specifies your prescription must be "dispensed as written," a CVS Caremark network pharmacist will automatically substitute an approved generic drug for a brand-name drug when available and legally permissible. If you request the brand-name drug in this event, you'll pay the brand name copayment plus the difference in cost between the brand-name drug and its generic equivalent. Compounded prescriptions are covered as a brand-name drug.
For example — For members whose retail prescription drug copayments are $5 for generic drugs and $10 for brand-name drugs:
If the generic drug costs $15 and the brand-name drug costs $60, you would pay the $10 copayment for the brand-name drug plus $45 (the difference in cost between the $60 brand name and the $15 generic drug). In this case, you would pay a total of $55 for the brand-name drug (instead of a $5 copayment for the generic drug).
For example — For members whose retail prescription drug copayments are $10 for generic drugs and $20 for brand-name drugs:
If the generic drug costs $40 and the brand-name drug costs $100, you would pay the $20 copayment for the brand-name drug, plus $60 (the difference in cost between the $100 brand-name drug and the $40 generic drug). In this case, you would pay a total of $80 for the brand-name drug (instead of the $10 copayment for the generic drug).
If the cost of a prescription is less than the copayment, you pay the lesser amount.
For example — If the in-network charge for a generic drug is $20, you'll be reimbursed as follows:
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If your generic drug copayment is $5, you'll be reimbursed $15 ($20 minus the $5 copayment).
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If your generic drug copayment is $10, you'll be reimbursed $10 ($20 minus the $10 copayment).
If the pharmacy bills you for a retail charge that's higher than the CVS Caremark discounted in-network charge, you will not be reimbursed for the portion of the charge that is above the in-network amount.
Many regional and national pharmacy chains, including Costco, Safeway, Rite Aid, Fred Meyer, Target, Walmart and Walgreens, as well as many independent pharmacies, participate in the CVS Caremark network.
If You Use a Nonparticipating Retail Pharmacy
The Trust Prescription Drug Plan is designed to help you save money on your prescription drugs when you use participating retail pharmacies. However, there may be times when you need to use a pharmacy that is not part of the CVS Caremark retail network.
If you use a nonparticipating pharmacy, you must pay the full cost of the prescription at the time of purchase. You may then file a claim for reimbursement with CVS Caremark.
The plan will reimburse 80% of the cost of covered prescriptions after you pay an annual deductible of $50 per person. Claim forms are available from the Trust Office or District HR/Benefits. Submit claim forms to:
CVS Caremark
P.O. Box 52116
Phoenix, AZ 85072
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