Prescription Drugs (YNHHS Plan)
What you need to know
You automatically have prescription drug coverage when you enroll in the YNHHS Medical Plan. You can fill covered prescriptions at participating CVS retail pharmacies, through mail order, or through YNHHS Outpatient Pharmacy Services.
Need to fill a prescription?
Filling Your Prescription
Your prescription will be covered only if it’s filled at a participating pharmacy. To fill 30-day supply prescriptions, just present your prescription and CVS Caremark prescription drug card at a pharmacy in the CVS Caremark network. To fill a maintenance medication, you must use a CVS retail pharmacy, mail order, or visit a YNHHS Outpatient Pharmacy. For specialty medications, you’ll need to use mail order or specialty pharmacy services, as described below.
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.
When you’re covered by the YNHHS Medical Plan, the out-of-pocket maximum is the most you’ll pay out of pocket for medical care and prescription drugs.
Pay nothing for certain preventive drugs
The Affordable Care Act (ACA) makes many prescription medications, vaccines, and supplements—including contraceptives and statins—available to you at no cost.
Save on Maintenance Drugs
For medications you take on an ongoing basis, you’ll use the CVS Caremark Maintenance Choice program to get refills at a lower copay for a larger supply. With CVS Maintenance Choice, you get up to two 30-day fills at a retail pharmacy before you’ll need to use CVS Caremark mail service or a CVS Pharmacy for 90-day fills.
What You Pay for Fills
What you’ll pay 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
90-day supply through CVS Maintenance Choice: $20 copay
Tier 2: Brand name
30-day supply: 20% coinsurance ($35 minimum, $80 maximum) if the drug is on the list of preferred brand drugs (the formulary)
90-day supply through CVS Maintenance Choice: 20% coinsurance ($70 minimum, $150 maximum) if the drug is on the list of preferred brand drugs (the formulary)
Tier 3: Non-preferred brand
30-day supply: 40% coinsurance ($55 minimum, $120 maximum) if the drug isn’t on the list of preferred brand drugs (the formulary)
90-day supply through CVS Maintenance Choice: 40% coinsurance ($110 minimum, $230 maximum) if the drug isn’t on the list of preferred brand drugs (the formulary)
Tier 4: Specialty
Up to a 30-day supply only through YNHHS Outpatient Pharmacy Services Generic and brand name: $20 copay
For certain high-cost specialty drugs not available through Outpatient Pharmacy Services or the Apothecary & Wellness Center, you’ll use CVS Specialty Pharmacy. These medications are subject to 40% coinsurance (up to $150 generic, $200 brand name).
7:30 a.m. to 5 p.m. ET
Choose the YNHH_PRD option
800-237-2767 (Specialty Pharmacy)
YNHHS Outpatient Pharmacy Services (YNHHS Medical Plan)
Apothecary & Wellness Center
YNHH Saint Raphael Campus