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?
Find a participating pharmacy near you.
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.
When a generic is available and you or your doctor chooses a brand-name drug, you’ll pay the brand-name coinsurance—plus the difference in cost between the two medications.
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.
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
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.
As a reminder, you only need to meet one combined annual out-of-pocket maximum for medical and prescription drugs. All your copays and coinsurance for covered services are applied toward this maximum. Once the out-of-pocket maximum is met, the plan pays 100% of eligible expenses for the remainder of the calendar year for each enrolled person.
Tier 1: Generic
30-day supply: $10 copay
90-day supply through CVS Maintenance Choice: $20 copay
Tier 2: Brand name
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
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).
Employees and/or their covered dependents who are enrolled in the YNHHS Medical Plan and take specialty medications can access a free program that will save them money by reducing out-of-pocket costs for eligible specialty medications.
CVS Caremark, YNHHS’ prescription plan administrator, has partnered with PrudentRx to offer this program for eligible specialty medications. If your specialty medication is on the PrudentRx Exclusive Specialty Drug List, you will have a $0 copay for your medication(s). If your medication is on the Prudent Rx Specialty Drug List, and you do not enroll in their program, you will pay 30% of the medication cost. To receive this benefit, specialty medications must be filled at the YNHHS Outpatient Pharmacy Services 844-881-0043 or the Apothecary & Wellness Center 203-789-4076.
To take advantage of this program or to see if your specialty medication is on the PrudentRx drug list, call PrudentRx at 800-578-4403, Monday through Friday, 8 a.m. – 8 p.m. Eligible employees must register first with PrudentRx before filling a prescription.
7:30 a.m. to 5 p.m. ET
Choose the YNHH_PRD option
800-237-2767 (Specialty Pharmacy)
YNHHS Outpatient Pharmacy Services
Apothecary and Wellness Center at Yale New Haven Hospital
Saint Raphael Campus, 1450 Chapel Street, New Haven, CT 06511