Prescription Plan

Pharmacy Benefits


Retail Pharmacy Maintenance Drug - Retail

Maintenance Drug - Mail Order or CVS Retail Pharmacy

Generic - Tier 1 $5 copay $15 copay $5 copay
Preferred Brand - Tier 2 $30 copay $90 copay $30 copay
Non-Preferred Brand - Tier 3 $45 copay $135 copay $45 copay

The table above reflects the 9/1/2015 plan changes. A maintenance prescription filled through mail order or at a CVS Retail Pharmacy location will cost only one (1) copay.

Retail = 34 day supply of drugs
Maintenance Drug = 90 day supply of a drug

Maintenance Drugs are taken regularly for an ongoing condition such as high blood pressure, diabetes, etc. You have two options to save money when filling a prescription for a maintence drug. You can pay just one (1) copay for a 90 day supply of a maintenance drug by filling the prescription at a CVS Retail Pharmacy or by using Mail Order.


Over-the-Counter Prescription Drugs

Over-the-counter (nonprescription) drugs, such as Prilosec, may be eligible under the Prescription Drug Plan. You must obtain a script from your physician to present to the pharmacist to get this benefit. If using the mail order program, you must also complete the mail order registration form.

Preventive Drug List

Under the Affordable Care Act, also known as health care reform, certain categories of drugs and other products were identified as preventive and are available to members at no cost. See the Preventive Drug List for those drugs and other products which are not subject to any copay or deductible when a prescription is written by a provider for members meeting the eligibility criteria below.


Mail Order

To order new prescriptions you’ll need to submit a Mail Service Order Form to CVS Caremark. CVS Caremark is the new mail order vendor effective January 1, 2014.  A new prescription will be needed if you wish to transfer an existing prescription from a retail pharmacy to mail order. Make sure the prescription is for a 90 day supply. Complete the order form and mail it to CVS. Be sure to include your payment and prescriptions when mailing. The customer service phone number for Mail Order is 1-800-241-3371. Also, refer to this overview of the prescription drug mail order program.

Mail Order Refills

You can order refills via a toll free number at 1-800-241-3371. The most convenient way to order your refills is online; it’s easy, private and convenient. You can also set up automatic refills of prescriptions.

Contact Information:

  • CVS Caremark Customer Service - 1-800-241-3371
  • CVS Caremark Mail Order Service - 1-800-241-3371

For further information regarding the Prescription Drug Plan Benefits, click here.