处方药保险
Retail and mail order prescription drug coverage is included when enrolled in a medical plan. 的 University prescription plan is administered by CVS Caremark. CVS Caremark使用处方药物列表. 的se lists are not all-inclusive and do not guarantee coverage. 除了使用这个列表, you are encouraged to ask your doctor to prescribe generic drugs whenever appropriate. 如欲了解更多有关配方表的资料，请浏览: http://www.caremark.com/portal/asset/药店连锁_recaprxclaimsdruglist.pdf. Employees can also access the formulary listing from their 药店连锁.com帐户. Formulary listings are maintained and controlled by a prescription benefits management company (PBM) and is subject to changes as directed by PBM.
身份证和医疗标志.com
CVS Caremark will send ID cards to employees' homes upon enrollment. Cards are in the employee's name, covered dependents will not receive cards in their name(s). Electronic cards are available through the 药店连锁.com帐户或CVS Caremarkbet8九州登录入口程序.
访问 http://www.caremark.com 创建一个账户来管理处方, 比较购物, 查看索赔和结余, 找到药房, 为一种药物或更多药物定价. Due to HIPAA guidelines the cardholder can only see those dependents on their account that are under the age of 18. Dependents 18 years and older will need to register separately. Dependents may grant family access to their account (top of the page – right corner, then under update my profile click on family access).
Elements of the CVS Caremark prescription drug plan include the Advanced Utilization 管理ment, Generics Preferred and Exclusive Home Delivery Programs. Effective 7/1/21 the PrudentRx专业药物共同支付计划 was applied to faculty and staff; members of the AFSCME 1699 bargaining unit are not eligible to participate.
PrudentRx专业药物共同支付计划
的 PrudentRx Specialty Drug Copay Program offered through CVS Caremark allows faculty and staff who enroll to have a $0 copay for their specialty drug prescriptions. Individuals who do not enroll in the program will be subject to a 30% co-insurance for specialty medications. 的re is no cost associated with joining the program.
的 PrudentRx专业药品上市 [PDF]定期更新. CVS Specialty Pharmacy may be reached at 1-866-387-2573 and PrudentRx at 1-800-578-4403.
高级利用管理方案
的se programs may require additional information from a prescribing physician in order for a prescription to be covered and paid for by the University’s health plan. Failure to provide additional information may result in a prescription not being covered by the health plan.
药品数量管理
药物数量管理, CVS Caremark monitors the amount of medication prescribed compared to the recommended level for a medication. 例如, if medical guidelines state a medication should be taken no more than once per day and a physician prescribes it for two times per day, CVS Caremark will reach out to the physician for justification regarding the higher amount prescribed. Sufficient justification will be required in order for the additional medication to be approved.
的se programs may require additional information from a prescribing physician in order for a prescription to be covered and paid for by the university’s health plan.
一步的治疗
接受分步治疗, an individual may be required to use a therapeutically equivalent and less costly drug where available and appropriate (such as a generic prescription) prior to being able to a more costly medication.
之前的授权
事先授权, CVS Caremark will require pre-approval be obtained for certain medications in order for the drug to be covered by the health plan. 对于需要事先授权的药物, a physician will be required to provide documentation that the patient meets the established medical guidelines for the medication. This may include prescriptions individuals are currently receiving.
请联系人力资源部 benefits@俄亥俄州.edu if you have any questions regarding these programs.
通用型优先项目
的 University's prescription drug plan includes a "generics preferred" program. When employees or family members need a new prescription or a refill for a brand-name drug, the pharmacist will check whether a generic drug is available instead. If a generic is available, employees are encouraged to utilize the generic option. If the employee chooses to use the brand-name instead of the generic, the employee will be charged the full cost difference between the generic and the brand-name drug. If there is no generic available, the employee will be charged the normal brand name copay.
维修选择-家庭交付计划
的 University’s 教师 and 工作人员 PPO health plan, and AFSCME 1699 PPO health plan include the CVS Caremark Maintenance Choice Program. Under this program plan members may receive two 30 day supply fills of ongoing, 任何零售药房的维持药物.
在那之后, members need to transition maintenance medications to 90 day supply prescription through one of the following options:
- CVS Caremark邮件服务药房
- CVS药房零售地点
- 克罗格药房地点*
- 好市多和好市多邮件服务药房*
Certain medications such as specialty medications, 附表二药物, or drugs with manufacturer or FDA supply limits may be exempted from the Maintenance Choice -Home Delivery Program. Members may contact CVS Caremark directly at 1-888-964-0089 about specific medications.
*2024年4月1日生效