Prescription Drugs

When you choose an ITW medical plan, you automatically get prescription drug coverage through CVS Caremark.

Overview

You can go to a retail pharmacy for your short-term medication needs (such as antibiotics). You can fill long-term or maintenance medications (such as insulin or blood pressure medication) only twice at a retail pharmacy. After that, you’ll need to fill them using Maintenance Choice (in person at CVS retail pharmacies) or mail order (through CVS Caremark).

If you fill a brand-name drug when a less expensive generic alternative is available, you’ll pay the difference between the cost of the brand name and the generic plus your copayment or coinsurance. But if your doctor believes that a generic option isn’t right for you, he or she can submit medical documentation to CVS Caremark and request approval to use a brand-name drug. If the request is approved, you will not have to pay the additional cost.

All three plans will cover generic preventive medications at no cost. The chart below shows what you pay to fill other prescriptions.

What You Pay to Fill Prescriptions

	HealthSaver	PPO1 and PPO2
Retail (up to a 30-day supply)
Preventive Generic	No cost to you	No cost to you
Generic	20% after the medical deductible	$20 copayment (or cost of prescription if less)
Preferred Brand	20% after the medical deductible	25% (up to $125)
Non-Preferred Brand	20% after the medical deductible	40% (up to $275)
Mail Order (up to a 90-day supply)/Maintenance Choice (90-day supply)
Preventive Generic	No cost to you	No cost to you
Generic	20% after the medical deductible	$40 copayment (or cost of prescription if less)
Preferred Brand	20% after the medical deductible	25% (up to $300)
Non-Preferred Brand	20% after the medical deductible	40% (up to $600)
Specialty (up to a 30-day supply)
Generic or Brand	20% after the medical deductible	$0 for eligible specialty medications when you are enrolled in the PrudentRx Copay Program or 30% if you are not enrolled in the PrudentRx Copay Program or the medication is not eligible for the program
Annual Prescription Drug Out-of-Pocket Maximum
Individual	Included in medical out-of-pocket maximum	$2,500
Family	Included in medical out-of-pocket maximum	$5,000

Note: There is a lifetime maximum of $20,000 for fertility prescription medication.

PrudentRx Copay Program

Employees and their family members with specialty prescription drugs — generally high-cost medications used to treat complex, chronic or rare conditions — who are enrolled in the PPO1 or PPO2 medical plan can take advantage of the PrudentRx Copay Program and get their eligible specialty prescriptions for $0. PrudentRx will reach out to you if you are taking an eligible specialty medication to enroll you in the program. If you don’t join the program or your medication is not eligible, you’ll pay 30% of the cost for the same medication. Note: fertility prescription medications are not included in the PrudentRx Copay Program.