Prescription Benefit

Your Prescription Drug Program is administered by CVS Caremark.

Be sure to also review your Prescription Drugs and Medicines Benefit in your Summary Plan Description for a complete listing of coverage and limitations.

Retail Program

Mail Service Program

When to Use

For prescriptions purchased at a local pharmacy

For maintenance or long-term medications

You Pay

• 10% ($7.50 minimum / $100 maximum) for each generic prescription
• 20% ($20.00 minimum / $100 maximum) for each brand name prescription on the Preferred Drug List
• 30% ($35.00 minimum / $100 maximum) for each brand name prescription no on the Preferred Drug List

• $20.00 for each generic
  prescription
• $40.00 for each brand name prescription on the Preferred Drug List
• $80.00 for each brand name prescription not on the Preferred Drug List