Prescription Drugs & Vaccinations

The prescription drug portion of the National Medical plans is administered by CVS/Caremark. You will receive a separate CVS/Caremark ID card for your prescription drug coverage. Through CVS/Caremark you can obtain prescription drugs through a national network of participating pharmacies through retail pharmacies or by mail. All Affordable Care preventive Drugs are covered at 10%. To see the coverage specifications for the National Medical plans, visit the medical plans overview page.

The CDHP Preventive Drug List (PDF, 280 KB) (separate from the Affordable Care Act preventive drug list) is covered at the applicable coinsurance level – meaning the deductible does not have to be met before the plan begins to pay its applicable portion. Federal regulations employ safe harbor coverage for these qualifying preventive medications, which allow them to be exempt from the deductible with high deductible plans. As a result, This drug list applies to the $1,850 and $3,300 deductible plans only.

If you are enrolled in one of the location-based medical plans, the prescription drug coverage is administered by those medical plans.

For more information on prescription drugs and preventive care, visit HealthCare.gov’s Health Benefits & Coverage page. Information about your medical per-paycheck contributions (which includes prescription drug costs) can be found on the Aptia365 website.

CVS/Caremark’s pharmacy network contains many national pharmacy chains such as Walgreens, Krogers, Rite Aid, Giant, Costco and more. This is the full list of major retail participating pharmacies (PDF, 83.2 KB).

A formulary is a list of prescription medications that are approved for use and coverage. Formularies are designed to guide healthcare providers and patients in selecting the most effective and affordable medications for treatment. The CVS Caremark formulary applies to all Aetna and Anthem medical plans.

Flu shots and the following non-seasonal vaccines are covered through participating CVS/Caremark pharmacies at no cost:

• Shingles
• Pneumonia
• Preventive care vaccines for children and adults (such as Measles, Tetanus, Diphtheria)

With the CVS Health app or by visiting Caremark.com, you can access the Check Drug Cost Tool. After logging into your account, look for the “Drug Pricing” button on your main dashboard. This feature allows you to enter the name and strength of your medication and search for pricing at nearby pharmacies.

If your medication is covered, the tool will display its price. If it’s not covered, you’ll see a message such as “Not Covered” or “Coverage Limitations.” In those cases, scroll down to view any preferred alternatives, along with their associated costs.

If your medication needs Prior Authorization, you’ll see a notification saying “Prior Authorization Required.” This tool is a helpful resource for getting detailed information about your medications and their coverage.