Prescription Drugs
2006 Prescription Coverage Options
Carnegie Mellon's medical insurance plans have prescription drug coverage provided through PharmaCare, including the HealthAmerica HMO. (The only exception is the Highmark HMO, which has prescription coverage provided through Merck-Medco.) There are two prescription coverage options through PharmaCare, which involve different monthly rates. 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. All plans include retail and mail order services.
- PharmaCare Formulary - select "Non-Formulary Drug and Formulary Alternative(s)". If the drug is not on the list, it is on the formulary.
- PharmaCare Participating Pharmacy Search - find a participating retail pharmacy near you
- PharmaCare Copayment/Coinsurance Calculator - find out what your copayment or coinsurance responsibility would be for a drug under option A or B.
Prescription Drug Participant Copays/Coinsurance
PharmaCare Option A |
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 medically necessary) |
$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 |
Not Covered* (unless medically necessary) |
$60 |
| Annual Out-of-Pocket Max (separate from medical plan) | None |
$1,500 indiv / $3,000 family
(retail & mail order) |
None |
* - Will be covered if medically necessary. Member will be responsible for 35% if the medication is deemed medically necessary. Your doctor must submit a PharmaCare Prior Authorization Request Form (.pdf) for this determination to be made.
PharmaCare Direct Mail Order or Walk-in Facility for Maintenance Medications
The Maintenance Medication Prescription Plan is the PharmaCare mail-order program for those taking maintenance medications on an ongoing basis. Although you may fill your maintenance medication prescriptions at a retail pharmacy, please note that an additional charge will apply after the third fill of the same maintenance drug at a retail pharmacy. You will be charged the retail copays for your supply PLUS the difference between the retail and the mail order price of the prescription.
Using PharmaCare Direct to fill ongoing medications will save you money, time and effort. For a much smaller cost, you can get up to a 90-day supply of the medication. To order refills, you can use the telephone, Internet or mail. You need not worry about running to a pharmacy every month - instead, you only need to get refills four times a year. PharmaCare Direct also maintains a walk-in facility where you can drop off and/or pick up maintenance prescriptions. This can be especially convenient if you need the medication immediately. The walk-in facility is open from 9:00 am - 5:00 pm, Monday - Friday. It is located at 620 Epsilon Drive, RIDC Park, Blawnox, PA 15238. (To use the walk-in facility for refills of maintenance medications, you should call 1-800-222-3383 to order the refill, and let the representative know that you will be coming into the walk-in facility to pick it up. Or you can bring a script with you and drop it off at the facility.)
Prescription Drug Monthly Rates for Full-Time Faculty and Staff
| Plan Level | PharmaCare Option A |
PharmaCare Option B |
Highmark HMO |
| Individual Employee | $ 20 |
$ 6 |
$ 28 |
| Employee and Child | $ 49 |
$ 25 |
$ 62 |
| Employee and Children | $ 57 |
$ 30 |
$ 72 |
| Employee and Spouse/DP | $ 65 |
$ 36 |
$ 82 |
| Family (Employee, Spouse/DP, and Child[ren]) | $ 98 |
$ 57 |
$ 121 |
Prescription Drug Monthly Rates for Part-Time Faculty and Staff
| Plan Level | PharmaCare Option A |
PharmaCare Option B |
Highmark HMO |
| Individual Employee | $ 47 |
$ 33 |
$ 55 |
| Employee and Child | $ 87 |
$ 63 |
$ 100 |
| Employee and Children | $ 99 |
$ 72 |
$ 114 |
| Employee and Spouse/DP | $ 110 |
$ 81 |
$ 127 |
| Family (Employee, Spouse/DP, and Child[ren]) | $ 156 |
$ 115 |
$ 179 |