PHARMACY BENEFIT

Eastman partners with CVS/caremark, your pharmacy benefits manager (PBM), to provide you with comprehensive prescription drug benefits. CVS/caremark’s goal is to make managing your prescriptions as easy as possible, and they are here to support you throughout the year.

How do pharmacy benefits work in a CDHP?

In the Eastman CDHP, prescription drug benefits work differently depending on whether or not you have reached the deductible. Before you reach the deductible, you will pay the full, discounted cost of your medications. Once you reach the deductible, you will pay copays/coinsurance with maximums and minimums. See the chart below for details.

Pharmacy Benefit with CVS/caremark CVS/caremark Retail Pharmacy Network
For short-term medications
(Up to a 30-day supply)
Generic Medications
Ask your doctor or other prescriber if there is a generic available, as these generally cost less.
$10 for a generic prescription (after deductible)
Preferred Brand-Name Medications
If a generic is not available or appropriate, ask your doctor or health care provider to prescribe from your plan's preferred drug list.
20% of medication cost max of $50 for a preferred brand-name prescription (after deductible).
Non-Preferred Brand-Name Medications
You will pay the most for medications not on your plan's preferred drug list.
40% of medication cost max of $100 for a non-preferred brand-name prescription (after deductible).
Specialty Drugs Not Applicable
Refill Limit Original fill plus 1 refill
Pharmacy Benefit with CVS/caremark Maintenance Choice
CVS/caremark Mail Service Pharmacy or CVS retail pharmacy

For long-term medications
(Up to a 90-day supply)
Generic Medications
Ask your doctor or other prescriber if there is a generic available, as these generally cost less.
$20 for a generic prescription (after deductible)
Preferred Brand-Name Medications
If a generic is not available or appropriate, ask your doctor or health care provider to prescribe from your plan's preferred drug list.
20% of medication cost max of $125 for a preferred brand-name prescription (after deductible).
Non-Preferred Brand-Name Medications
You will pay the most for medications not on your plan's preferred drug list.
40% of medication cost max of $250 for a non-preferred brand-name prescription (after deductible).
Specialty Drugs Specialty Drug Class 1-30 Day Supply Co-Pays
(After deductible)
Generic All (Tier 1) $10
Formulary Brand/Preferred Brand (Tier 2) 20%, Max $100
Non-Formulary Brand/Non-Preferred Brand (Tier 3) 40%, Max $150
Specialty Drug Class 31-90 Day Supply Co-Pays
(After deductible)
Generic All (Tier 1) $20
Formulary Brand/Preferred Brand (Tier 2) 20%, Max $225
Non-Formulary Brand/Non-Preferred Brand (Tier 3) 40%, Max $375
Refill Limit None
  • You have a combined annual deductible and out-of-pocket maximum. Medical and pharmacy expenses are combined and applied toward satisfaction of the annual deductible and out-of-pocket maximum.
  • Plan pays 100% for certain preventive drugs. Please see complete list of preventive drugs in the Health Care Summary Plan Description.
  • No out-of-network benefit for pharmacy services.
Note: When a generic is available, but the pharmacy dispenses the brand-name medication for any reason, you will pay the brand copayment/cost.

The preventive list includes certain diabetic supply and medication coverage at 100%. This list primarily features generic medications to continue providing quality care at a lower cost. There is also a preventive list as part of the Affordable Care Act that may impact you.

A new list of prescription drugs covered in your plan will go into effect in January, and some of your medications may be impacted. CVS/caremark will notify you if your medications are impacted.

Maintenance medications are drugs you may take on a regular basis to treat conditions such as high cholesterol, high blood pressure, or diabetes. Maintenance medications must be filled in 90-day supplies and you have two ways to get your refills - by mail through CVS/caremark or you can pick them up at a CVS/pharmacy near you.

The prior authorization process is used to determine the appropriateness of the medication as treatment based on certain criteria. Prior authorizations can be obtained by your doctor calling CVS/caremark.

Your ExtraCare® HealthCard from CVS/Caremark provides a 20% discount off thousands of CVS/pharmacy branded health-related items.

The CVS mobile app has several useful features. You can scan your prescription to order a refill, scan barcodes for information on drug-to-drug interactions, and even identify pills.

Download the app by texting "App" to CVSAPP (2877277) or visit the website.