Prescription Coverage Announcements COVID Test Kit Coverage Per federal mandate, effective January 15, 2022, the RI State Employee Health Plan will provide coverage for up to eight (8) over-the-counter (“OTC” - not prescribed by a physician) at-home COVID test kits per month for each covered member (employee and dependents). As of January 28, 2022, this coverage will be available exclusively through the member’s CVS/Caremark pharmacy benefit. There will be no coverage for OTC COVID test kits under the State’s medical benefit administered by Blue Cross & Blue Shield of Rhode Island (“BCBSRI”).* Please review CVS/Caremark’s FAQ and read on for additional information and guidance. How does this new coverage work? As of January 28, 2022, the State employee health plan’s coverage of OTC COVID test kits will be available exclusively through the CVS/Caremark pharmacy benefit. Each covered member (employee plus any dependents covered on the employee’s plan) will be eligible for coverage for up to eight (8) OTC COVID tests covered (up to $12 maximum per text kit) each month. The coverage will occur in one of two ways: Point-of-sale Adjudication: The vendor that sells you the test kits may be able to process your CVS/Caremark coverage information at the point of sale so that you don’t have to spend any money out of pocket (or if the test kits cost more than $12, your coverage will reduce each kit’s cost by that amount). If point-of-sale adjudication is not available to you, please be sure to keep your receipt so that you can submit a reimbursement claim to CVS/Caremark. Reimbursement: If you have to pay out of pocket for OTC COVID test kits, please be sure to save your receipts so you can submit a reimbursement claim to CVS/Caremark. Requests for reimbursement can be submitted to CVS/Caremark either through the member’s CVS/Caremark account access online through www.caremark.com or via paper claim form. For detailed guidance on how to request reimbursement from CVS/Caremark for OTC COVID test kits, please review the CVS/Caremark reimbursement guidance. Please note that any reimbursement requests submitted to BCBSRI for OTC COVID test kit purchases after January 27, 2022 will be denied.** Reimbursement for purchases between January 15, 2022 and January 27, 2022 I purchased OTC COVID test kits between January 15, 2022 - January 27, 2022. I did not present my CVS/Caremark and/or BCBSRI ID cards when I purchased them nor did I use my State employee health plan coverage for the test kits at the point of sale. Can I get reimbursed for the cost of those test kits? Yes. Please follow the CVS/Caremark reimbursement guidance to request reimbursement of qualifying OTC COVID test kits purchased from January 15, 2022 to January 27, 2022. Please note that you will need your OTC COVID test kit receipt in order to receive reimbursement. Also, please note that any reimbursement requests submitted to BCBSRI for OTC COVID test kit purchases after January 27, 2022 will be denied.** Reimbursement for test kits purchased prior to January 15, 2022. I purchased OTC COVID test kits prior to January 15, 2022. Can I get reimbursed for the cost of those test kits? The federal mandate does not have retroactive effect and only applies as of January 15, 2022 moving forward, so unfortunately this coverage is not available to reimburse/defray the costs of OTC COVID test kits purchased prior to January 15, 2022. However, please note that if you purchased those test kits because your doctor prescribed them, they could be covered 100% by your State employee health plan coverage (through either the medical benefit administered by BCBSRI or the pharmacy benefit administered by CVS/Caremark). * There is 100% coverage under the RI State Employee Health Plan (through either the medical benefit administered by BCBSRI or the pharmacy benefit administered by CVS/Caremark) for at-home COVID test kits that have been prescribed by a doctor. ** If you had already sent reimbursement requests to BCBSRI in late January/early February for purchases prior to 1/28/2022, the reimbursement will be processed. Overview State employees automatically receive prescription coverage administered by CVS Caremark when they enroll in one of the State's Anchor medical plans. Coverage Details Coverage Information Key Plan Features Combined out-of-pocket maximum for medical and prescription Anchor/Anchor Plus prescription drug co-pays levels: Generic: $10 Preferred Brand-Name: $35 Non-Preferred Brand-Name: $60 Specialty: $100 Anchor Choice prescription drug costs are 100% of retail cost until the deductible is met, then Anchor/Anchor Plus co-pay levels apply until the out-of-pocket maximum is met. EXCEPTION: Under Anchor Choice the Anchor/Anchor Plus co-pay levels are applicable for certain preventive therapy drugs before the deductible is met and until the out-of-pocket maximum is met. A broad but not completely comprehensive listing of these drugs can be found on the preventive therapy drug list below in the "Drug Lists & Costs" section. Savings Advisor – A new tool on Caremark.com that may help you save on the medications you need. View the Savings Advisor flyer or click on the "Drug Lists & Costs" tab for more information. Maintenance Choice – Save money by obtaining 90-day supplies of long-term maintenance medications for the co-pay price of a 60-day fill. AccordantCare™ – Provides free one-on-one support from nurses who are specially trained in complex conditions. What You Should Know Coverage is administered by CVS Caremark. You can fill short-term medications at any of the 68,000 participating pharmacies nationwide (including 7,500 CVS/pharmacy locations). If you use a non-participating pharmacy, complete the CVS Caremark Rx Claim Form to receive reimbursement for your out-of-network prescription claims. See the Medical/Prescription Plans Comparison or contact CVS Caremark for details regarding your prescription coverage. If you are enrolled in the Anchor Choice Plan, you will be required to pay the full cost for your medications until you reach your annual plan deductible. After you meet the deductible, you pay only the co-pay until you reach the annual out-of-pocket maximum. However, this deductible rule does not apply if you take medications on the Preventive Therapy Drug List—you pay only the copay for these medications even if you have not yet met your deductible. The State plan covers a variety of preventive prescriptions and products at no cost to you and any covered dependents. See CVS Caremark® Preventive Services List for complete detail on what is covered. (Note: Your doctor must write a prescription for these preventive services to be covered by your plan, even if they are listed as over-the-counter.) See the CVS FAQ for answers to common questions about your prescription coverage. Plan Comparison Click on the chart below to see the prescription coverages under Anchor, Anchor Plus and Anchor Choice. Coordination of Benefits The document below is a brief overview of how plan coverage works when someone has dual coverage. CVS Coordination of Benefits PDF file, less than 1mbmegabytes Taking a Specialty Medication? You will need to use CVS Specialty® to fill your specialty medications. If you try to fill a medication from the specialty pharmacy drug list (see "Drug Lists & Costs" section below) at your pharmacy of choice, you will be required to submit the prescription to CVS Specialty pharmacy. CVS Specialty provides personalized specialty pharmacist services like: A CareTeam who understands your condition. Access to a pharmacist and nurse specially trained in your condition. You can call them with questions anytime, any day of the year. Help for managing symptoms and side effects. Ability to send secure messages from your desktop or mobile phone. Option to choose pick up or delivery for your prescriptions. Pick them up at CVS Pharmacy® locations (including those inside Target stores) or have them delivered to your home, work or other place. Digital tools available on www.CVSspecialty.com and the CVS Specialty mobile app to help you stay on track with your prescriptions, order refills, get reminders and more. Taking a Maintenance Medication? Maintenance Choice® The State uses CVS Caremark's Maintenance Choice program. Under this program, you can save money by obtaining 90-day supplies of maintenance medications (see "Drug Lists & Costs" section below) for the co-pay price of a 60-day fill. This program applies to long-term maintenance medications ONLY and does not apply to short-term/acute medications like antibiotics. Specialty drugs are not available under the Maintenance Choice Program; they are available by mail through the CVS Specialty Pharmacy. Filling your maintenance prescription After one 30-day fill of a maintenance medication at any participating retail pharmacy, you will receive a letter from CVS Caremark with information on Maintenance Choice and instructions on how to proceed. If you fill your maintenance prescription at CVS/pharmacy, a CVS pharmacist can reach out to your doctor to help you obtain a 90-day prescription. If you fill your maintenance prescription at a non-CVS/pharmacy, you will need to obtain a 90-day prescription from your doctor unless you opt out of the Maintenance Choice program (see below). CVS Customer Care or mail order Under Maintenance Choice, you can pick up your 90-day supply at a CVS/pharmacy (including those located inside Target stores) or receive your order at home via CVS Caremark Mail Service Pharmacy. For pick-up at a CVS/pharmacy—call your CVS/pharmacy, and they can help you get a 90-day prescription from your doctor, or ask your doctor to send a new 90-day prescription to your CVS/pharmacy. For delivery by mail—sign in or register on www.caremark.com to request a new 90-day prescription, or call CVS Customer Care at 800-307-5432 for assistance through the process. Opt-out for 30-day fills You are not required to use CVS/pharmacy or CVS Caremark Mail Service Pharmacy to fill your maintenance medications. If you want to continue receiving 30-day supplies of your maintenance medications at your preferred non-CVS pharmacy, you can opt out of the program by contacting CVS Customer Care at 800-307-5432. Please note: If you continue to receive 30-day fills of your maintenance medications and do not opt out of Maintenance Choice, you will pay the FULL cost for your maintenance prescriptions, not the standard co-pay amounts. If you or your dependent(s) contact CVS Caremark to opt out of Maintenance Choice, the opt out will occur at the member level, not the drug level. This allows any eligible covered prescriptions for that member to be dispensed at any participating retail pharmacy without having to call CVS Caremark with every prescription. AccordantCare for Complex Conditions If you or a loved one suffer from a complex condition, AccordantCare™ from CVS/Caremark will be able to provide one-on-one support from nurses who are specially trained in complex conditions. It helps you or your covered dependent(s) stay as healthy as possible while living the best life possible. Best of all, this extra support is available on your terms. You can use the program as much or as little as you like. If you’re managing any of these complex conditions, you’re eligible for AccordantCare. It’s part of your Anchor medical plan at no extra cost. ALS CIDP CKD Crohn’s Disease Cystic Fibrosis Dermatomyositis Epilepsy Gaucher Disease Hemophilia Hereditary Angioedema HIV IBM JIA Multiple Sclerosis Myasthenia Gravis Parkinson’s Disease Polymyositis PAH Rheumatoid Arthritis Scleroderma Sickle Cell Disease SLE/Lupus Ulcerative Colitis Watch this video, and review the AccordantCare FAQ and AccordantCare flyer for more information. If you have questions or you’re ready to enroll, call AccordantCare at 844-948-0855 Monday – Friday, 8AM – 9PM ET. Need Help Understanding Your Plan? Visit the virtual benefits fair and the Decision Support page for tools such as ALEX® and benefits videos & presentations that can help you better understand your plan. Drug Lists & Costs Drug Formularies A drug formulary is a list of prescription drugs, both generic and brand name, that are preferred by the State's health plan.* CVS Caremark formularies are updated quarterly. January 1, 2023 Performance Drug List Standard Control Formulary (eff. 1.1.23) PDF file, less than 1mbmegabytes Advanced Control Specialty Formulary (eff. 1.1.23) PDF file, less than 1mbmegabytes Medications Requiring Prior Authorization (eff. 1.1.23) PDF file, less than 1mbmegabytes October 1, 2022 Performance Drug List Standard Control Formulary (eff. 10.1.22) PDF file, less than 1mbmegabytes Advanced Control Specialty Formulary (eff. 10.1.22) PDF file, less than 1mbmegabytes Medications Requiring Prior Authorization (eff. 10.1.22) PDF file, less than 1mbmegabytes July 1, 2022 Performance Drug List—Standard Control (eff. 7/1/22) PDF file, less than 1mbmegabytes Advanced Control Specialty Formulary (eff. 7/1/22).pdf PDF file, less than 1mbmegabytes Formulary Drug Removal List (eff. 7/1/22).pdf PDF file, less than 1mbmegabytes April 1, 2022 Performance Drug List—Standard Control (eff. 4/1/22) PDF file, less than 1mbmegabytes Advanced Control Specialty Formulary (eff. 4/1/22).pdf PDF file, less than 1mbmegabytes Formulary Drug Removal List (eff. 4/1/22).pdf PDF file, less than 1mbmegabytes Other Drug Lists Maintenance Drug List (December 2022) PDF file, less than 1mbmegabytes HSA Preventive Drug List (March 2023) PDF file, less than 1mbmegabytes * The State health plan does not cover erectile/sexual dysfunction drugs, allergenic extracts and drugs used for cosmetic purposes, even if they appear in the lists above. Check Your Prescription Cost Find out how much your prescription would cost under your health plan via the CVS Caremark Check Drug Cost Tool: Anchor Plan Anchor Plus Plan Anchor Choice Plan Savings Advisor Take advantage of Savings Advisor – a new tool on Caremark.com that helps you find savings opportunities on the medicine you need: If you've registered your account on Caremark.com and have enabled member communications, you will get an email from CVS Caremark when they identify a savings opportunity of $10 or more on prescriptions that cost $15 or more per fill. In your Caremark.com account, you can access a personalized Drug Savings opportunity page that shows any additional savings opportunities like switching to a lower-cost alternative medicine. See the Savings Advisor flyer for more information. Enrollment You are automatically enrolled in prescription coverage when you enroll in one of the State's medical plans. Please see Medical Coverage for more information on eligibility, the enrollment/waiver process, and premium rates. ID Card ID Card CVS Caremark mails ID cards to up to TWO people in your household. CVS Caremark ID cards are separate from your BCBSRI ID card(s). You can print extra cards by logging into your account at caremark.com, select Plan & Benefits at the top of the screen, then select Print Member ID Card. You can also order additional cards by calling CVS Caremark customer service at 800-552-8159. Contact / Member Portal If you haven't already, review the CVS FAQ for answers to common questions about your prescription coverage. If you have questions regarding your prescription coverage, please contact CVS Caremark: Download and register on the CVS Caremark mobile app. Register at the CVS Caremark member portal, www.caremark.com. Call customer service at 800-552-8159.