How the Prescription Drug Plan Works

 

The easiest way to determine your coverage category and what your drug will cost is to contact CVS Caremark at 1-888-291-6372 or www.caremark.com.

Specialty, Asthma, and Diabetes Drugs

Specialty drugs and brand name asthma and diabetes drugs have special coverage. Choose the appropriate topic in the navigation box to see how these drugs are covered.

There are three coverage categories in the Alcoa prescription drug plan: Generic, Brand 80/20 and Brand 50/50.

 

Generics 

  • If you buy your generic drug at a pharmacy, you pay 10% and the Plan pays 90%.
  • If you're taking a generic maintenance medication, consider filling it through the mail-order program - then it's free! If you continue to fill a maintenance prescription at your retail pharmacy after the first three fills, you'll pay an extra 10% coinsurance.


Brand 80/20

If there are no or limited generic alternatives to treat your condition, your brand-name drug is considered Brand 80/20.

  • If you buy this drug at a retail pharmacy or through the mail, you pay 20% and the Plan pays 80%.
  • If your drug has a generic equivalent, you pay the generic coinsurance plus the difference in cost between the brand-name and generic drug. The coinsurance maximum applies, but there is no maximum for the difference in cost. To save money, talk to your doctor about generic equivalents.
  • If you're taking a maintenance medication, consider filling it through the mail-  order program. If you use the retail pharmacy after three fills, you'll pay an extra 10% coinsurance. The coinsurance maximum applies, but not toward the extra 10%. To save money, use this safe and convenient service for filling your maintenance prescription.

 

Brand 50/50

If there are an appropriate number of generic alternatives available to treat your condition, your brand-name drug is considered Brand 50/50.

  • If you buy this drug at a retail pharmacy or through the mail, you first pay an annual deductible of $50 for an individual and/or $100 for families. After you meet the deductible, you pay 50% and the Plan pays 50%.
  • When your Brand 50/50 drug has a generic equivalent, you pay the generic coinsurance (10% if you go to a pharmacy or nothing if you order through the mail) plus the difference in cost between the brand-name and generic drug. Important: The coinsurance maximum applies, but there is no maximum for the difference in cost. To save money, talk to your doctor about generic equivalents.
  • If you're taking a Brand 50/50 maintenance medication, consider filling it through the mail-order program instead of at the pharmacy. If you continue to use the retail pharmacy after three fills, you'll pay an extra 10% coinsurance. The coinsurance maximum applies but not toward the extra 10%. To save money, use this safe and convenient service for filling your maintenance prescription.

 

Note: participants in a Health Savings Account (HSA) plan must meet the HSA deductible before benefits are paid.