Prescriptions

Associates and eligible dependent(s) who are enrolled in a PSEB medical plan receive prescription coverage at no additional cost. Read more below…

CVS Caremark Prescription Coverage

Associates enrolled in one of the Aetna medical plans receive prescription coverage through CVS Caremark at no additional cost.

Short-Term Medications

A retail pharmacy should be used when filling prescriptions for short-term medications such as antibiotics. Be sure to use an in-network CVS Caremark / Target pharmacy, or you may have to pay 100% of the cost.

When filling a short-term prescription at a retail pharmacy, simply present your Aetna ID card to the pharmacist. You will pay a coinsurance percentage, up to a copay maximum, of the total drug cost. You do not need to satisfy the plan’s deductible first.

Long-Term Maintenance Medications

Maintenance medications are those you take regularly for ongoing conditions, such as high blood pressure, cholesterol levels, diabetes, asthma, and arthritis.

You may use a retail pharmacy to obtain three 30-day refills for long-term maintenance medications. For your 4th and subsequent refills of long-term maintenance drugs, you are required to use the CVS Caremark mail service pharmacy or a CVS/Target retail pharmacy to receive a 90-day supply, otherwise you will pay 100% of the drug cost. You do not need to satisfy the plan’s deductible first.

Ask your doctor to write a new prescription for your plan’s maximum days’ supply with refills up to 1 year, as appropriate. You may mail your prescriptions in or ask your doctor to submit the request electronically or call 1-800-378-5697 for fax instructions. If your order is faxed, your doctor will need your Aetna member ID number found on your ID card.

Specialty Medications

If you have a complex or chronic condition (such as rheumatoid arthritis, multiple sclerosis, or psoriasis) then you need a specialty pharmacy, one that offers more than just medication.

  • Supply: 30 Days
  • Coverage: 60% ($200 copay maximum)

For more information contact Aetna Specialty Pharmacy at 1-866-782-2779 or visit www.aetnaspecialtyrx.com

Ask For Generic Drugs

Generic drugs have the same active ingredients, dosage, and strength as their brand name counterparts and can cost significantly less. Ask your physician if a suitable, alternative generic drug is available. If you do not use generic drugs when they are available, you will pay the difference between the cost of the generic and the brand name drug.

PRESCRIPTION DRUG COVERAGE (CVS CAREMARK)30-Day fill90-Day fill
GenericYou pay 30% (to $25)You pay 30% (to $50)
Preferred BrandYou pay 40% (to $50)You pay 40% (to $100)
Non-Preferred BrandYou pay 50% (to $75)You pay 50% (to $150)
SpecialtyYou pay 40% (to $200)Not covered – use retail

Triple-S Salud/Abarca Prescription Coverage

Associates enrolled in the Triple-S Salud medical plan receive prescription coverage through Triple-S Salud/Abarca at no additional cost.

Short-Term Medications

A retail pharmacy should be used when filling prescriptions for short-term medications such as antibiotics.

When filling a short-term prescription at a retail pharmacy, simply present your Triple-S Salud/Abarca ID card to the pharmacist. You will pay a copay based on the type of prescription and will receive a 30-day supply

Long-Term Maintenance Medications

Maintenance medications are those you take regularly for ongoing conditions, such as high blood pressure, cholesterol levels, diabetes, asthma, and arthritis.

You are encouraged to use the mail order program for long-term maintenance medications. When you use the home delivery mail order service, you will receive a 3-month supply for the cost of 2-months.

Ask your doctor to write a new prescription for your plan’s maximum days’ supply with refills up to 1 year, as appropriate. You may mail your prescriptions in or ask your doctor to call 808-941-4622 for fax instructions. If your order is faxed, your doctor will need your member ID number found on your Triple-S Salud/Abarca ID card.

Ask For Generic Drugs

Generic drugs have the same active ingredients, dosage, and strength as their brand name counterparts and can cost significantly less. Ask your physician if a suitable, alternative generic drug is available. If you do not use generic drugs when they are available, you will pay the difference between the cost of the generic and the brand name drug.

BENEFITRETAIL PHARMACY
SHORT-TERM DRUGS
MAIL ORDER
LONG-TERM DRUGS
Supply30-Day Supply90-Day Supply
GenericYou pay 30% ($25 copay maximum)You pay 23% ($50 copay maximum)
PreferredYou pay 40% ($50 copay maximum)You pay 30% ($100 copay maximum)
Non-PreferredYou pay 50% ($75 copay maximum)You pay 38% ($150 copay maximum)
Specialty Drugs
(must be filled at Specialty Product Network pharmacy)
You pay 40% ($200 copay maximum)Not covered – use retail

Learn More About Your Prescription Coverage

OptumRx Prescription Coverage

Associates enrolled in the HMAA medical plan receive prescription coverage through OptumRX at no additional cost.

Short-Term Medications

A retail pharmacy should be used when filling prescriptions for short-term medications such as antibiotics.

When filling a short-term prescription at a retail pharmacy, simply present your member ID card to the pharmacist. You will pay a copay based on the type of prescription and will receive a 30-day supply

Long-Term Maintenance Medications

Maintenance medications are those you take regularly for ongoing conditions, such as high blood pressure, cholesterol levels, diabetes, asthma, and arthritis.

You are encouraged to use the mail order program for long-term maintenance medications. When you use the home delivery mail order service, you will receive a 3-month supply for the cost of 2-months.

Ask your doctor to write a new prescription for your plan’s maximum days’ supply with refills up to 1 year, as appropriate. You may mail your prescriptions in or ask your doctor to call 808-941-4622 for fax instructions. If your order is faxed, your doctor will need your member ID number found on your member ID card.

Ask For Generic Drugs

Generic drugs have the same active ingredients, dosage, and strength as their brand name counterparts and can cost significantly less. Ask your physician if a suitable, alternative generic drug is available. If you do not use generic drugs when they are available, you will pay the difference between the cost of the generic and the brand name drug unless your doctor writes “dispense as written” on the prescription.

BENEFITRETAIL PHARMACY
SHORT-TERM DRUGS
MAIL ORDER
LONG-TERM DRUGS
Supply30-Day Supply90-Day Supply
Generic$12 copay
or 20% if cost of drug exceeds $250
$24 copay
or 20% if cost of drug exceeds $250 per 30 day supply
Preferred$24 copay
or 20% if cost of drug exceeds $250
$48 copay
or 20% if cost of drug exceeds $250 per 30 day supply
Non-Preferred$48 copay
or 20% if cost of drug exceeds $250
$96 copay
or 20% if cost of drug exceeds $250 per 30 day supply
Out-of-Pocket MaximumAssociate: $5,350
Associate + Dependent(s): $8,700
Associate: $5,350
Associate + Dependent(s): $8,700

OptumRx Drug Formulary

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