Welcome to the Prescription Drugs section of My Life at Children’s. Here you will find all the information you need about your prescription drug coverage. Select an option from the menu at the left for more details.
How the Plan Works
When you enroll in any of the Children's medical plan options, you automatically receive prescription drug coverage through CVS Caremark, which includes most pharmacy chains. You will receive a separate CVS Caremark ID card to use at the pharmacy. You will pay a percentage (coinsurance) of the retail cost of prescription drugs, with minimum and maximum dollar amounts. The percentage you pay depends on whether the drug is generic, preferred or non-preferred (see detailed definitions under Words to Know at the left).
The chart below shows your costs for prescription drugs based on the drug level.
|
Generic |
Preferred Brand |
Non-Preferred Brand |
| Retail: Up to a 30-Day Supply |
15%
Minimum $15,
Maximum $30 |
35%
Minimum $45,
Maximum $70 |
45%
Minimum $60,
Maximum $100 |
| Mail Order: Up to a 90-Day Supply |
15%
Minimum $30,
Maximum $60 |
35%
Minimum $90,
Maximum $140 |
45%
Minimum $120,
Maximum $200 |
Note: If the retail cost is less than the minimum, you will only pay the retail cost. For example, if the retail cost of your generic medication is $4 and the minimum is $15, you will pay $4. Do not forget to tell your pharmacist to process the charge through your insurance.
An Example of How Your Prescription Drug Plan Works
Here is an example of what you may for your prescription, based on the drug tier and retail cost.
| Tier |
If Your Retail Drug Cost Is
|
Coinsurance |
Minimum and Maximum |
You Pay |
| Generic |
$4 |
Not applied
|
$15 minimum
$30 maximum |
$4 — Because the original retail cost is less than the minimum, you pay the retail cost.
|
| Generic |
$50 |
15% = $7.50 |
$15 minimum
$30 maximum |
$15 — Because 15% ($7.50) is less than the minimum, you pay the minimum. |
| Preferred Brand |
$150 |
35% = $52.50 |
$45 minimum
$70 maximum |
$52.50 — Because 35% ($52.50) is between the minimum and maximum, you pay the 35% coinsurance. |
| Non-Preferred Brand |
$300 |
45% = $135 |
$60 minimum
$100 maximum |
$100 — Because 45% ($135) is over the maximum, you pay the maximum. |
Get More Information
- Take advantage of CVS Caremark's online information on the CVS Caremark Web site. See Contacts at the left.
- Call CVS Caremark. See Contacts at the left.
- Learn more about your prescription drug coverage with the Rx Drug Plan eLearning Tool. Look under Fast Clicks at the left.