Search



Change Text Size

Active Members Information: Prescription Drug Coverage

Summary

  • Three-Tier Copayment Plan - Generic, Preferred Drugs and Non-Preferred Drugs
  • Retail Prescriptions (up to 30-day supply) - Generic drug: $10; Preferred brand-name drug: $18, plus the cost difference between the brand and the generic, if one exists.; Non-preferred brand-name drug: $36, plus the cost difference between the brand and the generic, if one exists.
  • Mail Order through CVS Caremark Mail Service (up to 90-day supply) - Generic drug: $15; Preferred brand-name drug: $27, plus the cost difference between the brand and the generic, if one exists.; Non-preferred brand-name drug: $54, plus the cost difference between the brand and the generic, if one exists.
  • Maintenance Choice at a CVS pharmacy (up to 90-day supply) - Generic drug: $15; Preferred brand-name drug: $27, plus the cost difference between the brand and the generic, if one exists.; Non-preferred brand-name drug: $54, 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: $20; Preferred brand-name drug: $36, plus the cost difference between the brand and the generic, if one exists.; Non-preferred brand-name drug: $72, plus the cost difference between the brand and the generic, if one exists.

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.

For more information, refer to your Summary Plan Description or contact the PEBTF.

© 2014 Pennsylvania Employees Benefit Trust Fund. All rights reserved.
Contact webmaster@pebtf.org with any questions pertaining to the web site.