Prescription Drugs

Last updated date: 8/27/2024

You will automatically receive prescription drug coverage through CVS Caremark when you enroll in the In-network Only Plan, Choice Plan or High Deductible Plan with HSA.

Benefits-at-a-glance

	In-network Only Plan and Choice Plan	High Deductible Plan with HSA*
Deductible
	$100 per person/$200 family maximum	$1,800 individual/$3,600 family for in-network $2,800 individual/$5,600 for out-of-network Note: You must meet your combined medical/prescription drug deductible before the plan pays benefits.
Out-of-pocket Maximum
	$1,500 individual/$3,000 family	$5,000 individual / $10,000 family ($6,850 per individual) for in-network $7,500 out-of-network / $15,000 ($15,000 per individual) for out-of-network
Copay/coinsurance — In-network retail pharmacy
Generic drug**	$10
Preferred brand-name drug***	$30
Non-preferred brand-name drug	50% of the cost of the drug, with a minimum payment of $50, to a maximum of $150
Copay/coinsurance — Maintenance Choice program
Generic drug**	$20
Preferred brand-name drug***	$75
Non-preferred brand-name drug	50% of the cost of the drug, with a minimum payment of $125, to a maximum of $375
Copay/coinsurance — Specialty
Generic drug**	$0 with PrudentRx (see below)	$20
Preferred brand-name drug***	$0 with PrudentRx (see below)	25% of the cost of the drug, with a minimum payment of $50, to a maximum of $150
Non-preferred brand-name drug	$0 with PrudentRx (see below)	50% of the cost of the drug, with a minimum payment of $100, to a maximum of $250

*In the High Deductible Plan with HSA, you must meet your combined medical/prescription drug deductible before the Program will pay benefits, except for certain preventive drugs.

**The use of generic prescription drug equivalents whenever possible (through both the retail and CVS Caremark Mail Service programs) is more cost-effective. Ask your medical professional about this distinction. If you or your doctor requests a brand-name drug and a generic alternative is available, you will pay the difference between the cost of the brand-name drug and the generic drug in addition to the copay for the generic drug.

***Citi does not determine preferred brand-name drugs. Rather, CVS Caremark brings together an independent group of practicing physicians and pharmacists who meet quarterly to review the preferred brand-name formulary list and make determinations based on current clinical information. Call CVS Caremark Customer Care at 1 (844) 214-6601 or visit www.caremark.com for a copy of its Preferred Formulary (updated at least quarterly). Note: Preferred brand-name prescription drugs count toward the out-of-pocket maximum.

PrudentRx

You can take advantage of coupons that are available through PrudentRx for certain specialty medications. With these coupons, your medication will be free. If you don't use the PrudentRx program, you'll pay 30% coinsurance. PrudentRx will contact you if your medication is eligible, or you can call PrudentRx at 1 (800) 578-4403 for more information.

Through the Caremark Cost Saver program, you will automatically receive discounted prices on generic prescription drugs through GoodRx. When you submit a prescription to be filled at a retail pharmacy, your Caremark benefits and any available GoodRx discounts will be applied to ensure you pay the lowest available price. The amount you pay will automatically be applied to your plan's prescription deductible and out-of-pocket maximum. This program applies to generic medications only and is part of the prescription drug coverage you receive with the In-network Only Plan, Choice Plan, and High Deductible Plan with HSA.

Note: The Caremark Cost Saver program is not available in Florida.

In addition to choosing generic and using the Caremark Cost Saver program, here are some additional ways to save money on the medications you take.

Check if your preventive drugs are covered. The High Deductible Plan with HSA covers the cost of certain preventive drugs without having to meet a deductible. You will pay the applicable copay or coinsurance, which will count toward your combined medical and prescription drug out-of-pocket maximum. For a list of these preventive drugs, call CVS Caremark at 1 (844) 214-6601. You can also visit www.caremark.com.
Go to a network pharmacy. You can go to one of the thousands of pharmacies nationwide that participate in the CVS Caremark network. If you go to an out-of-network pharmacy, you will pay the full cost yourself, and then you can file a claim to be reimbursed at the contracted rate after you meet your deductible and pay the applicable copay.
Use PrudentRx for specialty medication. If you take specialty medication, you can save money with PrudentRx (offered through CVS Caremark). This program will optimize coupons that are available for certain specialty medications. If you use the program, these medications will be free; otherwise, you'll pay 30% coinsurance. You'll receive more information from CVS if this applies to you. You can also visit www.caremark.com or call 1 (844) 214-6601 for more information.

CVS Caremark offers three ways to purchase prescription drugs:

To find out whether a pharmacy participates in the CVS Caremark network, use one of the following methods:

Ask your pharmacist.
Visit www.caremark.com.
Download the CVS Caremark free mobile app from your device’s app store (search for “CVS Caremark”).
Call CVS Caremark Customer Care at 1 (844) 214-6601.

If you’re enrolled in a Citi medical coverage and you receive certain specialty drugs at an outpatient hospital facility, you may receive a letter from Citi about utilizing a different site of care for infusions. This would include receiving infusions for those drugs in an office setting, an infusion center or in the comfort of your own home.