Retiree Prescription Drug Benefit

http://www.caremark.com
(Non-Medicare only)
(866) 260-4646

https://mydocumentsource.memberdoc.com/
(Medicare Eligible only)
(866) 785-5711

CVS Caremark Prescription Plan Highlights (Non-Medicare Plan)
Copayments for generic, preferred and non-preferred brand prescription drugs, are per the following schedule:

Prescription Drug Class	30-Day Supply – Retail (Any Retail Pharmacy)	90-Day Mail Order 90-Day CVS/Pharmacy  (only)
Generics	$13	$21
Preferred brand	$25	$45
Non-preferred brand	$40	$65

• Maintenance Choice Program – plan participants who take maintenance medications have the choice to purchase their 90-day supply from the mail order program or purchase from a CVS/Pharmacy store and pay the same mail order copayment.
• Mandatory generics are required when available as well as using the mandatory specialty pharmacy program or specialty prescription drugs.
• Diabetic Meter Program – plan participants with diabetes may qualify for a free blood glucose meter when diabetic testing supplies are ordered through the mail order program.

CVS uses a formulary list of generics and preferred medications to keep your prescription copays at the lowest cost possible.  To see a complete list of the approved formulary medications, please review under your plan on the appropriate CVS website. The coverage offered through Silver Script is considered creditable coverage, meaning it is at least as good as the coverage offered through Medicare Part D. 

CVS Caremark - Medicare Eligible Plan Highlights

• CVS Mail Order Form
• CVS Mail Order User's Guide
• CVS Reimbursement Claim Form
• Prescription Drug Program Information