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Retired Members Information: REHP Drug Plan - Non-Medicare Eligible Members
Administered by CVS Caremark.
Summary
- Three-Tier Copayment Plan - Generic, Preferred Drugs and Non-Preferred Drugs
- Retail Prescriptions (up to 30-day supply) - Generic drug: $15; Preferred brand-name drug: $40, plus the cost difference between the brand and the generic,
if one exists.; Non-preferred brand-name drug: $80, plus the cost difference between the brand and the generic,
if one exists.
- Maintenance Choice (CVS, Costco or Kroger Pharmacy) and Mail Order - Generic drug: $22.50; Preferred brand-name drug: $60, plus the cost difference between the brand and the generic,
if one exists.; Non-preferred brand-name drug: $120, plus the cost difference between the brand and the generic,
if one exists.
- Retail Maintenance at a Rite Aid Pharmacy (up to 90-day supply) - Generic drug: $30; Preferred brand-name drug: $80, plus the cost difference between the brand and the generic,
if one exists.; Non-preferred brand-name drug: $160, plus the cost difference between the brand and the generic,
if one exists.
Preventive Care Covered Medications List – No Copayment
For Non-Medicare Eligible Members Enrolled in the REHP Prescription Drug Plan
The following medications are covered at no cost with a prescription from your doctor:
- Aspirin to help prevent illness and death from preeclampsia in individuals age 12 and older after 12 weeks of pregnancy who are at high risk for the condition
- Bowel preparation medications for screening colorectal cancer for adults age 45 through 74
- Contraceptives including emergency contraceptives and over-the-counter contraceptive products (condoms, sponges, spermicides, oral contraceptives)
- Folic acid daily supplement for individuals only age 55 or younger who are planning to become pregnant or are able to become pregnant
- Medications for risk reduction of primary breast cancer in individuals age 35 and older who are at risk
- Oral fluoride for preschool children older than six months to five years of age without fluoride in their water
- Tobacco cessation and nicotine replacement products – prescription drug coverage is for the generic form of Zyban or Chantix and nicotine replacement products (limited to a maximum of 168-day supply)
- Statins to help prevent serious heart and blood vessel problems (cardiovascular disease) in adults age 40 to 75 who are at risk. This covers generic low to moderate intensity statins only
- Antiretroviral therapy for pre-exposure prevention of Human Immunodeficiency Virus (HIV) infection in people who are at an increased risk
- Vaccines and immunizations to prevent certain illnesses in infants, children and adults
Remember that a prescription is required for you to obtain reimbursement for any of these preventive prescription drugs, even those that are available over the counter.
NOTE: These guidelines are subject to change.
If you use a pharmacy that does not participate in the CVS Caremark network, you pay the full cost of your prescription. You must then file a claim with CVS Caremark in order to receive reimbursement.
To find out if your pharmacy participates with CVS Caremark, call your pharmacy or contact CVS Caremark at
1-888-321-3261.
For Copayment Information, log on to the CVS Caremark Web Site: www.caremark.com. More information on the Prescription Drug Plan appears under the Publications/Forms section of this web site.
To review the Prescription Drug Formulary and other prescription drug related forms and publications, click here.
CVS Caremark www.caremark.com
For more information, refer to your REHP Benefits Handbook or contact PEBTF.
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