Meet the New Pharmacy Benefit Manager
We are moving our prescription drug benefits to CVS Caremark, effective January 2024. The change to CVS Caremark doesn’t limit your pharmacy options to just CVS Pharmacy locations. You’ll continue to have access to many of the same pharmacies as in the current network, or you may decide to take advantage of the expanded network options. Whether you stay with your existing pharmacy or change to a new one, you will need to present your new medical ID card.
LOWER COSTS THROUGH THESE ADDITIONAL PROGRAMS
Find more ways to save on your prescription medications with these three new programs.
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Silver HSA |
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Guidance to help you save: Rx Savings Solutions combines technology, clinical knowledge and data-driven research to provide price transparency and guidance that can help you save. It starts with a review of your claims to find the best options for you. You receive automatic notifications via text, email or direct mail. If you approve the suggestion, Rx Savings Solutions will do all the work for you, like getting provider approvals or transferring your prescription to a new pharmacy. |
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Save more with the CVS Cost Saver program: With the CVS Cost Saver program, you have automatic access to GoodRx pricing when you present your new medical ID card at your pharmacy. With this program, you pay lower prices, when available, on generic medications for common conditions like high cholesterol, high blood pressure and more. |
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Savings for specialty drugs: Under the Copay Option, coinsurance for specialty medications on the PrudentRx list are 30%; however, if you enroll in PrudentRx and sign up for available manufacturer copay assist programs, you may be eligible to pay $0 out of pocket. A PrudentRx Advocate will contact eligible members. |
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MORE TO KNOW
- You’ll continue to have access to many of the same pharmacies as in the current network, or you may decide to take advantage of the expanded network options.
- Most current prescription information will be automatically transferred from OptumRx to CVS Caremark. Simply present your new medical ID card at the pharmacy.
- For around 7,700 plan participants, the new Prescription Drug List (PDL) may affect coverage or costs. The PDL is a list of drugs covered by the medical options. It generally changes twice every plan year. Each pharmacy benefit manager has their own PDL, also sometimes called a formulary.
- Under the PDL, your prescription may not be covered or may move to a higher or lower tier, which would change the amount you pay. If there’s a change for any of the medications you take, you will receive a letter from CVS Caremark in November explaining what you need to do and the available support.
- If you take preventive medications, you can continue to use a retail network pharmacy for up to a 90-day supply. Or, you can use the CVS Caremark mail order pharmacy for up to a 90-day supply. The mail order pharmacy can save you money — and a trip to the pharmacy.
- If you have a complex health condition and need specialty drugs, you’ll need to fill them through the CVS specialty pharmacy. CVS Caremark will coordinate this transfer with your doctor. You’ll receive additional information in November.
TOOLS TO HELP YOU PREPARE:
- Check to see if your pharmacy is in-network. You can find a list of network pharmacies on the OE HQ.
- Use the CVS Caremark Check Drug Cost tool:
- Copay Option – Check Drug Cost (caremark.com)
- Gold HSA Pre Deductible – Check Drug Cost (caremark.com)
- Gold HSA Post Deductible – Check Drug Cost (caremark.com)
- Silver HSA Pre Deductible – Check Drug Cost (caremark.com)
- Silver HSA Post Deductible – Check Drug Cost (caremark.com)
- Review the PDL.
- Another great resources for tier classifications and pricing is the “Pricing and Coverage” tool available on mydelta.health.