What you need to know
Cigna medical plan enrollees can get prescriptions filled and refilled through the nationwide CVS Caremark pharmacy network (CVS, Walgreens, King Soopers, Costco, Sam’s Club, etc.) or CVS Caremark mail-order service.
Kaiser enrollees receive prescription drugs through Kaiser.
How the prescription drug plan works
You can get your prescriptions filled and refilled through the nationwide CVS Caremark pharmacy network or CVS Caremark mail-order service.
You can get a fill or refill of up to a 30-day supply at a retail pharmacy and up to a 90-day supply through the mail-order service or at your local CVS Caremark pharmacy.
On the third fill of the same prescription at a retail pharmacy, CVS Caremark will contact you to discuss transferring your prescription to a 90-day supply so you either receive your medications from mail service or at your local CVS Caremark pharmacy. If you fill these prescriptions anywhere else or in 30-day-supply increments, they will no longer be covered, and you’ll pay 100% of the cost. Visit info.caremark.com/baesystems to find a CVS Pharmacy near you or to get started with mail-order delivery.
Find a pharmacy near you or get started with mail-order service.
What you pay for prescriptions
HSA Standard and HSA Select plans
HSA Standard and HSA Select plans
The HSA Standard and the HSA Select plans require you to meet the plan’s annual deductible before the plan will begin to cover its share of the cost of prescription drugs.
Preventive medication
The Generics Only Preventive Therapy Drug List includes medications that help prevent chronic health conditions, such as high blood pressure, when taken regularly. If you take a medication that is on the Generics Only Preventive Therapy Drug List, you will only pay the 20% coinsurance amount, even if you have not yet met your annual deductible. To review the list, visit caremark.com/baesystems.
Remember, if you haven’t met your deductible, you will be responsible for paying the full cost of a non-preventive medication. Once you’ve met your deductible, you will pay 20% of the drug cost, up to a maximum copay amount.
Note: For maintenance or ongoing medications, you must transition your prescription to a 90-day supply after three refills, or you will be responsible for 100% of the cost. Fill your 90-day supply at a CVS Caremark pharmacy or through the CVS Caremark mail-order service.
| HSA Standard & HSA Select | |
|---|---|
| Retail (up to 30-day supply) | Under the HSA plans, after meeting your deductible, you pay 20% coinsurance, up to a maximum of: Generic: $15 per prescription Formulary brand: $50 per prescription Non-formulary brand: $100 per prescription Specialty drugs*: $75 per prescription (limited to 30-day supplies) |
| Mail order (up to a 90-day supply) | Under the HSA plans, after meeting your deductible, you pay 20% coinsurance, up to a maximum of: Generic: $37.50 per prescription Formulary brand: $125 per prescription Non-formulary brand: $250 per prescription |
* Specialty drugs must be filled through the CVS Caremark Specialty Pharmacy. Fills are limited to a 30 day supply.
Network Choice and Copay Plans
Network Choice and Copay Plans
With the Network Choice and Copay plans, the plan deductible does not apply, and you pay a copay amount per prescription.
| Network Choice & Copay | |
|---|---|
| Retail (up to 30-day supply) | Plan deductible does not apply, and you pay a copay amount of: Generic: up to $15 per prescription Formulary brand: $50 per prescription Non-formulary brand: $100 per prescription Specialty drugs*: 30% coinsurance per prescription ($0 if you enroll in the PrudentRx CVS savings program – see “PrudentRx Program for specialty drug savings”) limited to 30 day supplies |
| Mail order (up to a 90-day supply) | Plan deductible does not apply, and you pay a copay amount of: Generic: $37.50 per prescription Formulary brand: $125 per prescription Non-formulary brand: $250 per prescription |
* Specialty drugs must be filled through the CVS Caremark Specialty Pharmacy. Fills are limited to a 30 day supply.
Note: For maintenance or ongoing medications, you must transition your prescription to a 90-day supply after three refills, or you will be responsible for 100% of the cost. Fill your 90-day supply at a CVS Caremark pharmacy or through the CVS Caremark mail-order service.
PrudentRx Program for specialty drug savings
The Network Choice and Copay plans allow you to fill certain specialty medications at no cost by enrolling in the PrudentRx program. This program is designed to lower your out-of-pocket costs by assisting you with enrollment in drug manufacturers’ discount copay cards/assistance programs.
The program only applies to specialty medications for chronic, progressive conditions that are included on PrudentRx specialty drug list.
If you opt out of PrudentRx (or your specialty medication is not on the PrudenRx list), you will be responsible for the 30% coinsurance for specialty medications, up to the maximum copay per prescription.
The CVS Caremark Transform Diabetes Care program
The CVS Caremark Transform Diabetes Care program is a voluntary program that offers free services, support, and tools to Cigna medical plan members, spouses and dependents age 18 or older who are currently on medication to manage their diabetes.
Through the Transform Diabetes program, you can:
- Track your levels, see trends, and share your data with whomever you choose.
- Get unlimited test strips and lancets at no additional cost to you.
- Receive personalized tips in real time to help you stay on track and make informed choices.
CVS Caremark Transform Diabetes Care benefits also include:
- Two diabetes monitoring visits per year at MinuteClinic (at no additional cost to you) to help prevent diabetes-related conditions. These visits include A1c testing, foot exams, body mass index (BMI) assessments, diet consultation, and blood pressure and cholesterol checks.
- Personalized, one-on-one coaching with pharmacists to help you stay on track.
The CVS Caremark Transform Diabetes Care program is expanded to include the CVS-Medication Nutrition Management program. With the medication nutrition management program, you’ll have:
- Support from a team of clinicians, including a registered dietitian, who will help you develop a personalized nutrition plan.
- Oversight from a provider that will allow to you safely reduce or eliminate certain medications. This will be done in coordination with your own doctor.
If you or your dependent is eligible, you will receive a welcome kit from the CVS Caremark Transform Diabetes Care team.