Download Prescription Drug Plan

2013 Plan Year
Prescription Drug Plan
(For Sprint Consumer Access Plan)
(Administered by CVS Caremark)
You Pay……….
Annual deductible
(Mail and Retail Combined)
Does not apply to preventive, generic or
Specialty co-pays or any Dispense as
Written (DAW) penalty
In Network
Out of Network
$100/Individual
$200/Family
$400/Individual
$800/Family
Deductible cross applies between in and out of network services
Retail Pharmacy (up to a 31-day supply)
Generic (flat copay)
$5
$20
Brand-name formulary
You pay:
A maximum of:
20%
$100
30%
$150
Brand-name non-formulary
You pay:
A maximum of:
25%
$175
30%
$200
Generic equivalent drugs are required to
be substituted if available. You or your doctor
may request the brand name drug; however,
you will pay the cost difference.
*Specialty Drugs (31 day supply
max.)
You pay:
Generic and Brand-name formulary
Brand-name non-formulary
CVS Caremark Pharmacy Network
$100
$175
Nationwide network of more than 64,000 chain and independent pharmacies.
For a full listing, visit www.caremark.com
90 day Fill program
A mandatory 90 day fill requirement applies for all maintenance medications; You can receive a 90-day supply through
mail service or at a participating pharmacy through the Retail 90 program
Generic copay
$15
Brand-name formulary
You pay:
A maximum of:
20%
$150
Brand-name non-formulary
You pay:
A maximum of:
25%
$200
Mandatory 90-day fill requirement
After one fill and one refill of maintenance
medications at 31 days at retail, members
must obtain a 90-day supply by mail service
or at a Retail 90 network pharmacy.
Yes, for all maintenance medications
Mail Service
CVS Caremark Mail Service is another option available to you for obtaining your 90 day fill in addition to the Retail 90
option. It is suggested that you request two prescriptions from your doctor. One prescription is to obtain the initial 31day supply from a retail pharmacy. The second prescription should be written for a 90-day supply with three refills which
you may either send to the mail order pharmacy or obtain at retail.
Generic copay
$10.00
Brand-name formulary
You pay:
A maximum copay of:
15%
$150
Brand-name non-formulary
You pay:
A maximum of:
20%
$200
Drug Formulary
Customer Service
Preferred Drug List (PDL) can be found when you register at
www.caremark.com
CVS Caremark Customer Service: 855-848-9165
CVS Caremark Specialty Pharmacy: 800-237-2767
Additional Information
Generic Substitution: This prescription drug program contains a mandatory generic substitution provision. Generic
drugs can save a great deal of money — both for you and your plan. Many drugs are available in a generic form. A generic
medication is a chemically identical version of a brand-name medication approved by the U.S. Food and Drug
Administration (FDA). This means you get both quality and cost savings, because generic prices are on average 20 to 50
percent less than their brand-name counterparts. In addition, the copay amount for generics is generally less than for
brand names. Your choice of generics can help you keep your insurance premiums low and benefits high.
If you are taking certain brand-name medications, check with your doctor about the possibility of switching
your prescription to a generic alternative. Log on to www.caremark.com to check for cost-saving generics on
the Preferred Medication List.
When a generic drug is available, you must use the generic or pay the cost difference between the brandname drug and its generic equivalent along with your non-preferred copay.
Step Therapy: A medication management tool (called Step Therapy) is used to help ensure appropriate drug therapies
for certain conditions. These conditions include: diabetes, pain/inflammation, arthritis, depression, high blood pressure,
gastro-intestinal acid-peptic disorders, attention deficit disorder, atopic dermatitis, asthma, and certain congestive heart
failure treatments.
Prior Authorization (PA)-Some medications require a prior authorization by the Plan.
*Specialty Drugs: CVS Caremark Specialty Pharmacy is used for purchasing high-cost, injectable medications and
selected oral drugs known as Specialty Drugs, which are designed to target and treat chronic (long-term), lifethreatening, rare or often complex diseases including but not limited to, multiple sclerosis, rheumatoid arthritis,
hemophilia, cancer, and growth hormone deficiency. Specialty drugs usually require ongoing support/training, require
special handling/delivery, and they are much more costly than traditional medications. Due to the high cost of these
drugs, they will continue to be limited to a 31 day supply with a $100.00 brand or $175 non-brand copay . You can
receive these medications through a Specialty mail service pharmacy, which is designed to serve your unique needs and
deliver your medication to your doorstep. If you have questions about this process, you or your physician can contact CVS
Caremark toll free at 800-237-2767.
Helpful Tools and Resources
Prior to becoming a member, CVS Caremark offers a website that will assist you with verifying covered prescriptions as
well as providing information regarding your out of pocket costs. Just go to www.caremark.com/sprint to access benefit
information or call 1-855-848-9165 to speak to a customer service representative.