Prescription Drug Coverage
Eligible prescription drugs are covered according to your plan coinsurance, after a copayment, and when filled at pharmacies that participate in Caremark. If you use pharmacies that are not part of the network, you have no prescription drug coverage. A pharmacy directory lists participating drug stores in the pharmacy network.
You pay a copayment each time you have a prescription fill for a generic drug, preferred brand drug, or a non-preferred brand drug. However, if your doctor prescribes a generic drug and you decide to purchase a brand-name drug, you are responsible for the brand-name drug copayment plus the actual cost difference between the generic drug and the brand-name drug.
A mail-order plan is available for puchasing an extended supply of maintenance or long-term drugs. The program can help save money on prescription drugs that you use regularly. When you fill your prescription through mail order, you are covered up to a 90-day supply. You pay a copayment each time you have a mail-order prescription filled for a generic or brand-name drug.
Caremark Rx
Juniata College has selected Caremark Rx, Inc. as the retail and mail order pharmacy benefit manager beginning January 1, 2007.
Caremark Rx, Inc. is a leading pharmaceutical services company, providing through its affiliates comprehensive drug benefit services to over 2,000 health plan sponsors and their plan participants throughout the U.S. Caremark's clients include corporate health plans, managed care organizations, insurance companies, union, government agencies and other funded benefit plans. The Company operates a national retail pharmacy network with over 60,000 participating pharmacies, seven mail service pharmacies, the industry's only FDA-regulated repackaging plant and 21 licensed specialty pharmacies for delivery of advanced medications to individuals with chronic or genetic diseases and disorders.
During the transition from Express-Scripts to Caremark Rx, current mail order prescriptions on file with Express-Scripts will be transferred to Caremark Rx. In cases where the prescription is at the end, or close to expiration, employees will need to obtain a new prescription and submit it to Caremark Rx. Please note that you will not be able to register on Caremark.com until January 1, 2007.
Co-Pay Structure
Retail Pharmacy
Offered for a co-payment of $10 for a generic drug, 10% of the cost of the drug with a mininum of $20 and a maximum of $100 for a preferred brand drug and 10 % of the cost of the drug with a minimum of $40 and a maximum of $100 for a non-preferred brand drug. There is a $50 annual deductible for each covered family member on brand name drugs only.
Mail Order
There is also a mail in prescription program offered for medications you take on a regular, long-term basis. You will receive up to a 90 day supply at a reduced rate. Co-pays for generic drugs are $20, preferred brand $40, non-preferred brand $80.
Additional Information
Caremark Rx Preferred Drug List (effective 4/1/08)
Caremark Rx Preferred Drug List (effective 1/1/08)
Caremark Rx Preferred Drug List (effective 10/1/07)
Caremark Rx Full Formulary (49 pages)
Caremark Rx Participating Retail Pharmacies
Please refer to your Summary of Benefits for further pharmacy information.