CVS Caremark remains your prescription benefit manager in 2024.
All three of the medical plans have prescription coverage through CVS Caremark. The three medical plans have the same copay/coinsurance amounts and a large network of pharmacies. For a full list of in-network pharmacies, please visit www.caremark.com.
Through CVS Caremark, point-of-sale (POS) rebates will be given to members. CVS Caremark negotiates with the drug companies to establish rebates for certain drugs. For example, a drug may have a list price of $250 with a rebate of $100. In the past, an employee would have been responsible for the full $250 until their deductible was met. However, with the point-of-sale rebates, an employee will only be responsible for paying $150 at the time they pick up their prescription. In this example, the employee would save $100. Not only do POS rebates save employees money, they also make prescription purchases more transparent.
The easiest way to manage your prescriptions is through CVS Caremark’s website or mobile app. Within both platforms, you may review your mail order prescription, check drug costs and coverage, find a network pharmacy and keep track of your prescription spending. You may also transfer a current prescription or submit a new one by simply submitting a picture of the prescription label or written prescription. For additional ease, you can even enroll in automated refills. To get started, all you need to do is register at www.caremark.com or download the CVS Caremark mobile app.
Below is a quick look at the 2024 prescription coverage.
| Prescription Drug Coverage Deductible must be met before coinsurance rates apply | |||
|
Retail Pharmacy Network (Up to 30 day supply) |
Mail Service Pharmacy (Up to 90 day supply) |
Retail Pharmacy Network (Up to 90 day supply) | |
| Preventive Medicines (mandated by the ACA) |
$0 (no deductible) |
$0 (no deductible) |
$0 (no deductible) |
| Generic Medicines | $10 copay | $20 copay | $30 copay |
| Preferred Brand-Name Medicines |
20% Min. $30, Max. $50 |
20% Min. $60, Max. $100 |
20% Min. $90, Max. $150 |
| Non-Preferred Brand-Name Medicines |
40% Min. $50, Max. $70 |
40% Min. $100, Max. $140 |
40% Min. $150, Max. $210 |
| Specialty Medicines |
40% Min. $75, Max. $150 (30 day supply) | ||
If you have any questions about how this change will impact you, please feel free to contact the Benefits Hotline at 317-232-1167 or toll free at 877-248-0007 (if outside of Indianapolis).
Prescription Coverage Quick Links
Maximize Your Out-of-Pocket Savings on Prescription Medications
As a State of Indiana employee, you have access to benefits designed to make your healthcare more affordable and convenient. Here are some ways you can save up to thousands of dollars annually in out-of-pocket expenses on prescription medications:
- Check out CVS’s Drug Cost and Coverage tool on the CVS/Caremark website. All you have to do is create an account and use the Plan & Benefits tab to find the Check Drug Cost & Coverage tool. Use this tool to search for drugs to see plan coverage, generic alternatives and cost at your pharmacy. This means that you’re never caught off guard by the price of your medication at the counter again.
- Get 90-day prescriptions by mail for the most savings: Save time and money with a 3-month prescription for your medication. Whenever available, CVS/Caremark’s Mail Service Pharmacy costs less than retail.
- Check programs like Good Rx and Mark Cuban Cost Plus Drugs for special deals. Because these programs focus on just a few medications, they can sometimes offer an even better deal than the already discounted pricing you get through your insurance. Good Rx and Mark Cuban Cost Plus Drugs focus on low cost generic medications.
- Check the drug manufacturer’s website for discount programs. Manufacturer programs are usually for brand name medications. If you are able to take advantage of these low cost programs, you will have one extra step to take to make sure what you pay counts towards your deductible and out-of-pocket maximum.
To illustrate the potential savings, let’s look at some examples:
You need to fill a prescription for a common injectable drug for inflammatory conditions which now offers a generic called a biosimilar. You decide to check CVS’s Drug Cost Tool and discover big savings if you choose home delivery through CVS/Caremark mail service for your prescription:
- Brand name: The cost is $5,884.
- Biosimilar at retail: The cost is $2,183.
- Biosimilar at mail: The cost is $1,320.
You need to fill a prescription for a common generic ADHD medication. You’ve checked CVS’s Drug Cost Tool, but want to make sure you are getting the best price so you also check GoodRx:
- Health Plan Price: $311.81
- GoodRx Price: $75.66
You need to fill a prescription for a common generic heartburn medication, and would like to get a 90 day supply. You decide to check Mark Cuban Cost Plus Drugs to make sure you are getting the best price:
- Our Health Plan Price: $46.60
- Mark Cuban Cost Plus Drugs Price: $14.00
Special note to maximize your benefits while also getting the best price:
When you use GoodRx or Mark Cuban’s Cost Plus Drugs, you are filling a prescription outside of your health plan. To make sure those expenses are counted towards your deductible, or to get reimbursed for what the plan should have covered, you must submit a Prescription Reimbursement Claim Form to CVS/Caremark. You can do this electronically by logging in at www.caremark.com and navigating to Plan & Benefits > Reimbursement Claims > Submit a New Claim. Remember that the INSPD Benefits Hotline is here to help if you have any questions. Take advantage of these benefits and start saving today!
For more information on your prescription coverage and to explore the full list of in-network pharmacies, visit www.caremark.com. By making informed choices about where you fill your prescriptions, you can make a big difference in your healthcare costs. Save money, stay healthy and make the most of your benefits as a valued State of Indiana employee.
Need help with your prescription drug benefits? Contact the INSPD Benefits Hotline at 877-248-0007.