Prescription Drug Plan
CVS/Caremark administers Baylor University’s prescription drug benefit plan, designed to assist members in obtaining prescriptions with cost-effective choices. The cost of prescriptions is determined by your medical insurance plan, the pharmacy service used to fill it, and the category of the drug. Additionally, some preventive service prescriptions may be available to you at no cost. You are automatically enrolled in the prescription drug plan administered by CVS/Caremark when you enroll in one of the Baylor medical plans (PPO or HDHP).
Prescription Costs Overview
PPO
Retail Pharmacies:
| Brand | 30-Day Supply Cost |
|---|---|
| Generic | $10 |
| Preferred Brand | $40 |
| Non-Preferred Brand | $80 |
| Specialty-Filled with CVS Specialty Only | $120 Limit |
Mail Service:
| Brand | 90-Day Supply Cost |
|---|---|
| Generic | $25 |
| Preferred Brand | $100 |
| Non-Preferred Brand | $200 |
HDHP
Annual Deductible*:
| Type | Deductible Cost |
|---|---|
| Individual | $1,500 |
| Family | $3,000 |
Co-Insurance, Once Deductible* Is Met:
| Brand | Plan Pays |
|---|---|
| Generic | 80% |
| Brand-Name | 70% |
NOTE: If you have family coverage, you will be required to satisfy the Family Deductible before receiving medical or prescription coverage for any member of your family.
Potential Additional Costs for Both Plans (PPO & HDHP)
- Generic Drugs: A mandatory generic plan for prescriptions is in place. Dispense as Written (DAW) 2 rules apply. If you or your doctor choose the brand-name drug over the generic alternative, you will be responsible for payment designated by the plan and possibly an additional fee based on drug cost. Please review the Generic Drug list to identify generic medications that may substituted for brand names prescriptions.
- Formulary Drugs: If a drug is excluded on the formulary, you may be responsible for full charges. Please review the Formulary Drug Exclusions List.
- Specialty Drugs: Specialty drugs are used in the management of specific chronic and/or genetic conditions and often include injectable or infused drugs and may also include oral drugs. If a drug is on the Specialty Drug List, a clinical review will be conducted by CVS/Caremark medical personnel in conjunction with the doctor to ensure the patient receives the best approach to therapy.
- Step Therapy Drugs: Step Therapy means trying less expensive and risky options before "stepping up" to more costly and risky drug therapies. Under a Step Therapy program, it is required that participants try using one or two generic medications before certain brand name medications will be covered. If a drug is on the Step Therapy list and you/your doctor choose to fill the brand name drug, you may be responsible for full charges. Please review the Step Therapy Drugs Lists: Requires Generic First Chart and Sample List of Drug Options Chart (may not include all available drugs).
