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Pharmacy Benefits

Pharmacy benefits are included when you and your dependents enroll in a health plan.

A Summary of Your Prescription Drug Benefits

Generic (tier one) drug: You'll pay the lowest amount. A generic medicine is FDA approved and equal to the brand name product in safety, effectiveness, quality and performance.

Preferred brand (tier two) drug: You'll pay a higher amount. Many popular and highly used preferred brands are included on the preferred drug list (PDL).

Non-preferred brand (tier three) drug: You'll pay the highest amount. These belong to the most expensive group of drugs. These drugs are not included on the PDL.

Specialty drug tier: In the PPOs, 10% coinsurance applies with a member minimum ($50, unless the drug cost is under $50, then you would pay the full cost of the drug) and a maximum ($150) out-of-pocket. Members enrolled in a CDHP pay coinsurance for specialty drugs.

Did you know?
CVS/caremark has website tools to help you compare costs for your prescriptions. You can also find out what you have spent in the past. Learn more by calling 877.522.8679 or go to info.caremark.com/stateoftn. You must register to view your prescription history and costs.

Finding a Caremark Network Pharmacy

More than 67,000 independent and chain pharmacies are available throughout the U.S. All offer 30-day prescriptions. If you take a longer term medication, more than 916 Tennessee “mail at retail” pharmacies also fill 90-day prescriptions. Mail service is also available.

You can find a 30-day or 90-day network pharmacy through the Caremark website at info.caremark.com/stateoftn.

You can also call Caremark customer service at 877.522.TNRX (8679) to find a network pharmacy near you.

Maintenance Drugs

There are lower out-of-pocket costs on a large group of maintenance drugs. To pay the lower price for these certain medications, you must use the special, less costly Retail-90 network (pharmacy or mail order) and fill a 90-day supply of your medication. The maintenance tier list includes certain medications for high blood pressure, high cholesterol, coronary artery disease, congestive heart failure, depression, asthma/chronic obstructive pulmonary disease (COPD), and diabetes (oral medications, insulins, needles, test strips and lancets).

Certain Low-Dose Statins

Eligible members will be able to receive these medications in-network at zero cost share in 2018. These medications are primarily used to treat high cholesterol. No high dose or brand statins are included.

Copay Installment Program

Members can spread the cost of 90-day mail order prescriptions over a three-month period — at no additional cost. You may enroll online at info.caremark.com/stateoftn, register and log in, or by calling CVS/caremark customer care at 877.522.8679. This benefit is only for 90-day mail order prescriptions provided by CVS/Caremark mail order. This does not apply to specialty medications.

Weight Management

There are some obesity medications available for members who meet certain requirements. This gives members a less costly, non-surgical option for losing weight. Go to info.caremark.com/stateoftn to look for covered medications. They are found under “Antiobesity” on the preferred drug list (PDL).

Diabetic Supplies

OneTouch diabetic testing supplies are the only diabetic testing supplies covered at the preferred brand copay. Members will have lower copays by using OneTouch supplies. Diabetics may be eligible for a new OneTouch glucose meter at no charge from the manufacturer. Click here for more information or call 800.588.4456.

Flu and Pneumonia Vaccines

Each year, members can get free flu and pneumonia vaccines (if eligible) through certain pharmacies or at your doctor’s office. View the 2017-2018 flu and pneumococcal vaccine coverage information sheet on how to access this free benefit.

Tobacco Cessation Products

Members who want to stop using tobacco products can get free tobacco quit aids.

The following quit aids are FREE under the pharmacy benefit:

Members may receive up to two, 12-week courses of treatment per calendar year (up to 168 days of treatment) with no lifetime maximum. A licensed clinician is required to write a prescription to get any tobacco cessation products at no cost, including over-the-counter aids. Simply present your prescription and your Caremark card at the pharmacy counter (not at the check-out registers) to fill at $0 copay. The plan only covers generic over-the-counter tobacco cessation products (not brand names).

Compound Medications

Any and all compound medications (as determined by the pharmacy benefits manager) must be processed electronically.  Paper claims will not be reimbursed and will be denied.  In addition, many compound medications require prior authorization by the pharmacy benefits manager before claims processing and determination on payment will occur.

Appeals

Members have the right to appeal a denial made by Caremark. There are three levels of appeal available: