Prescription Drugs (HDHP Plans)
What you need to know
Until you meet your annual deductible, you’ll pay the full cost of your prescription drugs. Those costs are applied against your deductible, and you can use funds in your HSA or HRA to cover them.
You can fill covered prescriptions at participating CVS retail pharmacies or through CVS Caremark mail service. For specialty medications, you’ll need to use specialty pharmacy services, as described below. You will pay the actual cost of your prescription, as negotiated between CVS Caremark and the pharmacy.
Pay nothing for certain preventive drugs
Need to fill a prescription?
Find a participating pharmacy near you.
You can fill up to a 30-day supply of a prescription at more than 5,000 participating pharmacies in the Connecticut, New York, and New Jersey area (64,000 nationwide), including major pharmacy and supermarket chains and most independent drug stores. To determine if a pharmacy is part of the CVS Caremark network, view the online pharmacy provider directory at caremark.com.
When you fill a short-term prescription, such as a 30-day supply, at a participating pharmacy, simply present the prescription and your CVS Caremark prescription drug card.
In an emergency or if you’re out of state and can’t get to a participating pharmacy, you’ll pay out of pocket and then file a claim for reimbursement from CVS Caremark.
No-cost vaccines when you use the right ID card
You and your covered dependents can get no-cost vaccines for shingles, pneumonia, flu (ages 18 and older only), COVID-19, tetanus/diphtheria, and hepatitis A and B. To ensure 100% coverage, show the right ID card. If you are in a CVS Minute Clinic or Health Hub, use your medical plan ID card. Any other network pharmacy, use your CVS Caremark ID card.
What You Pay for Fills
The High-Deductible Health Plans have a combined annual deductible for medical and prescription drug services. You’ll pay the full cost of services until you meet your deductible; for prescription drugs, you’ll pay the actual cost of your medication, as negotiated between CVS Caremark and the pharmacy.
Under these plans, the most you’ll pay out of pocket for medical care and prescription drugs in any calendar year is $3,000 per individual or $6,000 per family.
How much you’ll pay for your prescription depends on the type of medication and the amount prescribed. When the cost of a drug is less than the minimum copay, you’ll pay the lower amount.
Tier 1: Generic
30-day supply: $10 copay after deductible
31- to 90-day supply: $10 copay after deductible through CVS Caremark mail service
Tier 2: Brand Name
30-day supply: $25 copay after deductible, if the drug is on the list of preferred brand drugs (the formulary)
31- to 90-day supply: $50 copay after deductible through CVS Caremark mail service
Tier 3: Non-Preferred Brand
30-day supply: $40 copay after deductible, if the drug isn’t on the list of preferred brand drugs (the formulary)
31- to 90-day supply: $80 copay after deductible through CVS Caremark mail service