Prescription Drugs
Carnegie Mellon's prescription drug coverage is provided through CVS/Caremark (formerly known as PharmaCare) for all medical plans, except the Highmark HMO (which has prescription coverage provided through Merck-Medco.)
- There are two prescription coverage options through Caremark/PharmaCare, which involve different monthly rates.
- Caremark/PharmaCare Formulary - choose from the "Preferred Choice Formulary" options.
- Caremark/PharmaCare Copayment/Coinsurance Calculator - find out what your copayment or coinsurance responsibility would be for a drug under either option.
- Caremark/PharmaCare Pharmacy Locator (supported by Internet Explorer only) - find your closest participating pharmacy.
- Our plans include retail and mail order services. (Caremark Mail Order Service Patient Profile Enrollment Form (.pdf))
- If you elect medical coverage through Carnegie Mellon, you must select one of the pharmacy plans for the same individuals that you covered under the medical plan. If you opted out of Carnegie Mellon medical coverage, you cannot enroll in our prescription drug coverage.
- The Highmark HMO coverage must be selected by participants in that health plan. Those not enrolled in the Highmark HMO cannot select the Highmark HMO prescription coverage.
Prescription Drug Participant Copays/Coinsurance
Caremark (PharmaCare) Option A |
Caremark (PharmaCare) Option B |
Highmark HMO Prescription |
|
| In-Network Retail | (Up to 30-day supply) |
(Up to 34-day supply) |
|
| Generic (automatic substitution) | $10 |
$5 |
$10 |
| Brand Name - on the Formulary - No generic available - Generic available |
$15 $25 |
35% ($100 maximum) |
$15 |
| Brand Name - Non-formulary | $40* |
Not Covered* (unless |
$30 |
| Mail Order (Up to 90-day supply) | |||
| Generic (automatic substitution) | $20 |
$10 |
$20 |
| Brand Name - on the Formulary - No generic available - Generic available |
$30 $50 |
35% ($200 maximum) |
$30 |
| Brand Name - Non-formulary | $80* |
$60 |
|
| Annual Out-of-Pocket Max (separate from medical plan OOP maximum) |
None |
$1,500 indiv / $3,000 family
(retail & mail order combined) |
None |
* - Medical Necessity Waivers: Non-formulary medications will be covered at the formulary level if they are deemed medically necessary. Your doctor must submit a medical necessity waiver form in advance that demonstrates why the formulary medicine can not be used (and/or why a non-formulary medication must be used).
2008 Prescription Drug Monthly Rates for Full-Time Faculty and Staff
| Plan Level | Caremark (PharmaCare) Option A |
Caremark (PharmaCare) Option B |
Highmark HMO |
| Individual Employee | $ 23 |
$ 7 |
$ 28 |
| Employee and Child | $ 56 |
$ 28 |
$ 62 |
| Employee and Children | $ 65 |
$ 34 |
$ 72 |
| Employee and Spouse/DP | $ 75 |
$ 40 |
$ 82 |
| Family (Employee, Spouse/DP, and Child[ren]) | $ 112 |
$ 64 |
$ 122 |
Prescription Drug Monthly Rates for Part-Time Faculty and Staff
| Plan Level | Caremark (PharmaCare) Option A |
Caremark (PharmaCare) Option B |
Highmark HMO |
| Individual Employee | $ 53.00 |
$ 37.00 |
$ 57.50 |
| Employee and Child | $ 98.00 |
$ 71.00 |
$ 105.00 |
| Employee and Children | $ 111.00 |
$ 80.50 |
$ 118.50 |
| Employee and Spouse/DP | $ 124.00 |
$ 90.50 |
$ 132.50 |
| Family (Employee, Spouse/DP, and Child[ren]) | $ 175.50 |
$ 129.00 |
$ 187.00 |
For more information:
- Generic Drugs FAQ (.pdf)
- Caremark/PharmaCare Formulary List - choose from the Preferred Choice Formulary options
- Caremark/PharmaCare Pharmacy Search and Copayment/Coinsurance Calculator (supported by Internet Explorer only)
- Caremark Mail Service Patient Profile Enrollment Form (.pdf)
- 2008 Benefits Workbook for Full-Time Employees (.pdf)
- 2008 Benefits Workbook for Part-Time Employees (.pdf)