Prescription Coverage (2019)

Overview

Eligible State employees automatically receive prescription coverage when they enroll in one of the State's medical plans. Coverage is effective on the first day of state employment.

Coverage Details

What's New in 2019

  • Combined out-of-pocket maximum for medical and prescription
  • New prescription drug co-pays and addition of a fourth tier for specialty drugs:
    • Generic: $10
    • Preferred Brand-Name: $35
    • Non-Preferred Brand-Name: $60
    • Specialty: $100
  • Transform Diabetes Care—A new program that provides resources like test strips and lancets and counseling to help you manage your diabetes, all free of charge.

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.)

Plan Comparison

Click on the chart below to see the prescription coverages under Anchor, Anchor Plus and Anchor Choice.

medical insurance plan comparison from 2019

Plan Documents

A brief overview of how plan coverage works when someone has dual coverage.

Taking a Specialty Medication?

You will need to use CVS Specialty® to fill your specialty medications. 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 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/pharmacy 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/pharmacy at 1-888-769-9030 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 1-800-307-5432. 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.

New! Transform Diabetes Care

The State is excited to introduce Transform Diabetes Care (TDC), a new CVS/Caremark program to help you manage your diabetes at no charge to you. Highlights include:

diabetic test strips

Receive a connected Livongo® glucometer that includes free test strips and lancets

woman smiling

Free diabetic coaching by Livongo Certified Diabetic Educator

screen of diabetic monitoring device

Two free diabetic monitoring visits (including A1C check) at any Minute Clinic location

See the TDC flyer or visit start.livongo.com (access code RHODEISLAND) to learn more about TDC and sign up.

Need Help Understanding Your Plan?

talk to Alex smiley face

Visit the Decision Support page for tools such as ALEX®, the State Employee Benefits Guide and benefits videos & presentations that can help you better understand your plan options and make the best choice for you and your family.

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.

Descriptions:

Performance Drug List - Standard Control is a list of formulary non-specialty drugs

Advanced Control Specialty Formulary is a list of formulary specialty drugs

Formulary Drug Removal List is a list of drugs that require a prior authorization for medical necessity and their covered alternatives.

Effective January 1, 2019

Effective April 1, 2019

Effective July 1, 2019

Effective October 1, 2019

Please note: The State health plan does not cover weight loss/anti-obesity drugs, erectile/sexual dysfunction drugs and allergenic extracts, 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:

Other Drug Lists

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.

Please contact CVS Caremark if you have questions regarding your prescription coverage: