CVS/Caremark

Generic Incentive Program: Members will be required to pay the appropriate drug copayment plus the difference in cost between the generic equivalent and brand name drug if a generic equivalent is available. A generic equivalent drug contains the same active ingredient(s) as the brand name drug and work the same way and must meet the same rigorous U.S. Food and Drug Administration for standards of quality, strength, purity and potency. Should a prescription be written with a Dispensed as Written (DAW) and a generic is available, members will be required to pay the appropriate drug copayment plus the difference in cost between the generic equivalent and the brand name drug. Mail order prescriptions will automatically be filled with a generic equivalent whenever available unless the brand drug is specifically requested by the member or physician.

Cost Management Programs: Certain high cost drugs may be subject to prior authorization and/or step therapy requiring that generic and lower cost alternative brand therapies are attempted prior to most costly alternatives.

Routine Maintenance Medications: Members must fill all routine maintenance medications through mail order or 90-day script at retail at CVS/Caremark.

Specialty Mail Order: Accredo will help members to manage their specialty prescription needs. Specialty pharmacy involves complex medications that often require special handling. Accredo will not only help to coordinate delivery but serve as a support for the members that utilize specialty prescriptions.

Prudent Rx: Saves plan members money on specialty drugs by maximizing prescription drug copay assistance from pharmaceutical manufactures with coupons. This program is like the SaveOn SP program that was previously in place with Express Scripts.