Caremark prescription drug mail service

TI Retiree Health & Wellness Benefits

Caremark

Prescription drug mail service

The Pharmacy Plan, administered by Caremark, offers a prescription drug program that provides mail delivery service as well as in-network and out-of-network pharmacy benefits.

The following tables present prescription benefits. The coinsurance percentage amount that you pay and the annual out-of-pocket maximum may depend on the prescription option you selected in your plan.

Pre-Medicare Participants Prescription Benefits

Type	In-Network	Out-of- Network	Mail-Order Program
Generic	You pay 45% or 60% of the total cost.	You pay 50% or 65% of the total cost.	You pay 40% or 55% of the total cost for up to a 90-day supply.
Brand name (generic available)	You pay 45% or 60% of the total cost, plus the cost difference between the brand name and generic drug.*	You pay 50% or 65% of the total cost, plus the cost difference between the brand name and generic drug.*	You pay 40% or 55% of the total cost for up to a 90-day supply, plus the cost difference between the brand name and generic drug.*
Brand name (no generic available)	You pay 45% or 60% of the total cost.	You pay 50% or 65% of the total cost.	You pay 40% or 55% of the total cost for up to a 90-day supply.
Annual out-of-pocket maximum**	$0 deductible and $5,000 individual / $10,000 family out-of-pocket maximum or $100 individual/$200 family deductible and $10,000 individual / $20,000 family out-of-pocket maximum

Medicare-Eligible Participants Prescription Benefits

Type	In-Network	Out-of- Network	Mail-Order Program
Generic	You pay 45% of the total cost.	You pay 50% of the total cost.	You pay 40% of the total cost for up to a 90-day supply.
Brand name (generic available)	You pay 45% of the total cost, plus the cost difference between the brand name and generic drug.*	You pay 50% of the total cost, plus the cost difference between the brand name and generic drug.*	You pay 40% of the total cost for up to a 90-day supply, plus the cost difference between the brand name and generic drug.*
Brand name (no generic available)	You pay 45% of the total cost.	You pay 50% of the total cost.	You pay 40% of the total cost for up to a 90-day supply.
Annual out-of-pocket maximum**	$0 deductible and $5,000 individual / $10,000 family out-of-pocket maximum

*If a generic is available and a brand-name drug is purchased instead, you pay the appropriate coinsurance for the generic drug cost plus the cost difference between the brand-name and generic drug. The cost difference does not apply towards the pharmacy out-of-pocket maximum — you must still pay the difference, even if your out-of-pocket pharmacy maximum has been met.
** The out-of-pocket pharmacy maximum does not include deductibles or the cost difference you pay if a brand-name drug is received when a generic is available.

Visit the Caremark Web site for forms and a description of services offered, including online refill and order status, and your prescription history information. Due to privacy considerations, separate accounts must be set up for each dependent, in addition to the primary member. If you need assistance in setting up online accounts, contact the Caremark Internet Team at 800-990-1940. Caremark prescription drug claim forms are also provided on the BCBS Claim forms Web site.

Prescription drug prices posted at the Costco Pharmacy web site reflect comparable retail pharmacy prices, of which you would pay 45% (or 60%, if Pre-Medicare and depending on your plan selection) for generic drugs and brand name drugs without generic availability.

Contact Caremark via HR Connect: 888-660-1411(or directly at 800-557-5749).