Prescription Drug Coverage

Prescription drugs are covered under all medical plans.

If you're an Aetna or UHC member, you can buy medications through CVS Caremark, the prescription benefit provider. You can pick up your non-specialty prescriptions at a CVS pharmacy or CVS Caremark in-network pharmacy such as Walgreens, Costco, or Kroger. See the CVS Caremark FAQ [PDF] for more information about registering online, filling prescriptions, and specialty medications. 

Key things to know when you need a prescription
Prescriptions under the HDHPs
Find the cost of a prescription
How to fill a prescription
See what makes the CVS Specialty pharmacy “special”
Easy ways to save

Key things to know when you need a prescription

  • There are three types of medications: generic, brand medications on the formulary, and non-formulary medications.
    • Generics are generally the least expensive type of medication. You can save up to 80% by choosing a generic drug instead of a brand-name drug. They’re modeled after brand-name medicines and are nearly identical. They are simply listed under their “chemical name”—usually without any marketing. This means that other companies can make and sell the same medicine at a reduced price. 
    • Brand medications on the formulary list are generally the second-least expensive option. What is a formulary? A drug formulary is a list of prescription drugs used by practitioners to identify drugs that offer the greatest overall value. Medications on a formulary are chosen by a panel of experts who are independent of your insurance company, including doctors, nurses, pharmacists, and other clinical experts.
    • You’ll pay significantly more for non-formulary medications. Brand-name drugs not on the formulary are still covered by the plan, but you’ll pay the most for these.
  • Some drugs are covered at 100%. These include generic and brand oral contraceptives, all prescribed forms of birth control, and generic maintenance drugs for asthma, diabetes, hyperlipidemia, and heart disease.

Find out more about a specific medication through Caremark.com.

Conveniently manage prescriptions at Caremark.com

Watch this quick 90-second video to see the easy-to-use digital services and tools available to you when you register on Caremark.com.

Prescriptions under the HDHPs

When you enroll in the HDHP Premium or HDHP Standard plans, you automatically receive prescription drug coverage through CVS Caremark. You pay 100% for your prescriptions at the discounted cost until you reach your deductible. Your deductible is combined with your medical deductible. Once your deductible is met, you’ll pay the copays shown below.

Tip! You can use your HSA dollars to pay for prescription drug costs that count toward your annual deductible. After you meet the deductible, you can use your HSA to pay the cost of prescription copays. 

Retail prescriptions (30-day supply)

  In-network* Out-of-network
Generic $10 copay after deductible Not covered
Brand formulary $25 copay after deductible Not covered
Brand non-formulary $40 copay after deductible Not covered

* Deductible waived for certain drugs considered preventive. These include generic and brand- name oral contraceptives, all prescribed forms of birth control, and generic maintenance drugs for asthma, diabetes, hyperlipidemia, hypertension, and heart disease. Please review the CVS Caremark Preventive Drug List [PDF] to see all preventive drugs that apply.

Mail order or Maintenance Choice Program (90-day supply)

  In-network* Out-of-network
Generic $20 copay after deductible Not covered
Brand formulary $50 copay after deductible Not covered
Brand non-formulary $80 copay after deductible Not covered

* Deductible waived for certain drugs considered preventive. These include generic and brand- name oral contraceptives, all prescribed forms of birth control, and generic maintenance drugs for asthma, diabetes, hyperlipidemia, hypertension, and heart disease. Please review the CVS Caremark Preventive Drug List [PDF] to see all preventive drugs that apply.

CVS Caremark’s Maintenance Choice Program

Maintenance Choice lets you receive a 90-day maintenance prescription at a retail CVS Caremark pharmacy, including those inside Target stores, for the same copay you’d pay when using the mail-order program. It offers you the convenience of same-day prescription availability and the opportunity to speak with a CVS Caremark pharmacist face-to-face. Keep in mind that the prescription must be written for a 90-day supply, plus any appropriate refills.

Find the cost of a prescription

Use the Check Drug Cost tool to find the cost of a medication, or call Customer Care at 1-844-345-2824:

How to fill a prescription

For short-term medications (like antibiotics):

Fill your prescription anywhere in the CVS network of more than 68,000 pharmacies nationwide, including chain pharmacies, 20,000 independent pharmacies, and 9,700 CVS Pharmacy® locations (including those inside Target stores).

For long-term medications (such as for high blood pressure or diabetes):

One cost-effective option is to have your prescription delivered to your door or pick it up at a CVS retail pharmacy. To sign up for mail service:

  • Register at www.caremark.com/startnow and follow the instructions to request a new 90-day prescription, or
  • Call Customer Care at 1-844-345-2824.

To pick up your 90-day supply at a CVS retail pharmacy:

  • Bring a new prescription to your local CVS Pharmacy location or have your prescriber submit a prescription to the CVS Pharmacy of your choice, or
  • Call Customer Care at 1-844-345-2824.

For specialty medications

Specialty/biotech medications must be filled through the CVS Caremark Specialty Pharmacy.

The specialty drug program is specifically designed to help members who have rare and/or complex chronic health conditions, such as infertility, multiple sclerosis, and rheumatoid arthritis. To see if your prescription is a specialty medication, check out the specialty pharmacy listing of medications. If your prescription is a specialty medication, you'll need to enroll separately in this program, which provides additional resources and customer support. Due to the specialty nature of these medications, you may find additional limits on the availability of these medications. Call the CVS Caremark Specialty Pharmacy toll-free at 1-800-237-2767, or visit www.cvsspecialty.com.

See what makes the CVS Specialty pharmacy “special”

Remember: The medical plan deductible applies to all prescriptions, except preventive prescriptions, so you’ll need to meet the deductible before the plan starts to share the cost for prescriptions. Once you’ve met the deductible, you’ll pay a copay.

Easy ways to save

Here are some simple steps you can take to keep your prescription drug costs down:

  1. Choose generics. If your doctor recommends or prescribes a brand-name drug, ask if there’s a generic version. Most of the time, a generic is available that’s just as effective, but for a lower cost.
  2. Use preferred brands when you need a brand-name drug. Like it does with generics, the CVS Caremark plan has a list of preferred brand-name drugs that are generally less expensive than their non-preferred brand-name equivalents. Ask your doctor to recommend a preferred brand-name drug. You can view the most recent covered drug list by logging on to Caremark.com.
  3. Use mail order or Maintenance Choice for drugs you take regularly.